Randall Allen Whitaker, MSW, LCSW, CASAC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

000791 Issued in MO

Practice address

126 Missouri Ave
MCXP-CCS-CR
Fort Leonard Wood, MO 65473-8952

Phone

(573) 596-0417

Fax

(573) 596-0524

NPI assigned

Jul 31, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1154304000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1164438263",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "126 MISSOURI AVE",
            "address_2": "MCXP-CCS-CR",
            "city": "FORT LEONARD WOOD",
            "state": "MO",
            "postal_code": "654738952",
            "telephone_number": "573-596-0417",
            "fax_number": "573-596-0524"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "126 MISSOURI AVE",
            "address_2": "MCXP-CCS-CR",
            "city": "FORT LEONARD WOOD",
            "state": "MO",
            "postal_code": "654738952",
            "telephone_number": "573-596-0417",
            "fax_number": "573-596-0524"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WHITAKER",
        "first_name": "RANDALL",
        "middle_name": "ALLEN",
        "name_prefix": "Mr.",
        "credential": "MSW, LCSW, CASAC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-31",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MO",
            "license": "000791",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brett Weir, DNP
• Barbara Ann Welch, LCSW
• Marie T Welton, DDS
• Joni Kay West, PMHNP
• John L Westhoff II, M.D.
• Becky Jo White, LPN
• Barry Dwayne Whiteside, PT
• Michelle L Whitlock, PSY.D.
• Robin Annette Whitmore, CHN
• Shelly Mae Wiley

• Clinical Social Worker in Fort Leonard Wood, MO
• Providers in Fort Leonard Wood, MO by specialty
• Clinical Social Worker in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.