Active NPI
Takiya Kajuan Paicely, MSW, LCSW, DCC
- Student in an Organized Health Care Education/Training Program
- Spokane, WA
National Provider Identifier
1184963902
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Student in an Organized Health Care Education/Training Program
- License
- CG60965821
- Practice address
- 17 E 1St Ave
Spokane, WA 99202-1501 - Phone
- (509) 838-4651
- Fax
- (509) 363-2762
- NPI assigned
- Feb 14, 2013
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 34006655A | IN | |
| Student in an Organized Health Care Education/Training Program | 390200000X | CG60965821 | WA | Primary |
Addresses
Primary practice location
17 E 1St Ave
Spokane, WA 99202-1501
Mailing address
107 S Division St
Spokane, WA 99202-1510
Phone (509) 838-4651
Other names 1
- Takiya Kajuan Gardner
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| CG60965821 | WA | MD | Student in an Organized Health Care Education/Training Program |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Frontier Behavioral Health | Clinical | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1360800000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1570752000000",
"number": "1184963902",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "107 S DIVISION ST",
"city": "SPOKANE",
"state": "WA",
"postal_code": "992021510",
"telephone_number": "509-838-4651",
"fax_number": "509-363-2762"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "17 E 1ST AVE",
"city": "SPOKANE",
"state": "WA",
"postal_code": "992021501",
"telephone_number": "509-838-4651",
"fax_number": "509-363-2762"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PAICELY",
"first_name": "TAKIYA",
"middle_name": "KAJUAN",
"credential": "MSW, LCSW, DCC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2013-02-14",
"last_updated": "2019-10-11",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "IN",
"license": "34006655A",
"primary": false
},
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": "WA",
"license": "CG60965821",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "TAKIYA",
"last_name": "GARDNER",
"middle_name": "KAJUAN",
"code": "5",
"type": "Other Name"
}
]
}Other providers in Spokane, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.