Active NPI
Joshua Randall Wentz
- Social Worker
- Walla Walla, WA
National Provider Identifier
1093394801
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- 61084954
- Practice address
- 77 Wainwright Dr
Walla Walla, WA 99362-3975 - Phone
- (509) 525-5200
- NPI assigned
- Apr 7, 2021
- Last updated
- Apr 7, 2021
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | 61084954 | WA | Primary |
Addresses
Primary practice location
77 Wainwright Dr
Walla Walla, WA 99362-3975
Mailing address
1360 SW Greeley St
College Place, WA 99324-5004
Phone (509) 301-8969
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 61084954 | WA | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1617753600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1617753600000",
"number": "1093394801",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1360 SW GREELEY ST",
"city": "COLLEGE PLACE",
"state": "WA",
"postal_code": "993245004",
"telephone_number": "509-301-8969"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "77 WAINWRIGHT DR",
"city": "WALLA WALLA",
"state": "WA",
"postal_code": "993623975",
"telephone_number": "509-525-5200"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WENTZ",
"first_name": "JOSHUA",
"middle_name": "RANDALL",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2021-04-07",
"last_updated": "2021-04-07",
"certification_date": "2021-04-07",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "WA",
"license": "61084954",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Walla Walla, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.