Active NPI
Donna Jeanne Vidales
- Clinical Social Worker
- Austin, TX
National Provider Identifier
1235896580
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 14641
- Practice address
- 14508 Owen Tech Blvd Apt 316
Austin, TX 78728-0007 - Phone
- (361) 648-5280
- NPI assigned
- Nov 22, 2021
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 14641 | TX | Primary |
Addresses
Primary practice location
14508 Owen Tech Blvd Apt 316
Austin, TX 78728-0007
Mailing address
14508 Owen Tech Blvd Apt 316
Austin, TX 78728-0007
Phone (361) 648-5280
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 |
|---|---|---|---|
| 14641 | TX | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1637539200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1637539200000",
"number": "1235896580",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "14508 OWEN TECH BLVD APT 316",
"city": "AUSTIN",
"state": "TX",
"postal_code": "787280007",
"telephone_number": "361-648-5280"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "14508 OWEN TECH BLVD APT 316",
"city": "AUSTIN",
"state": "TX",
"postal_code": "787280007",
"telephone_number": "361-648-5280"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VIDALES",
"first_name": "DONNA",
"middle_name": "JEANNE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2021-11-22",
"last_updated": "2021-11-22",
"certification_date": "2021-11-22",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "TX",
"license": "14641",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Austin, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 22, 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.