Active NPI
Susan Klinger Walloch, MSSW LCSW
- Clinical Social Worker
- Chippew Falls, WI
National Provider Identifier
1255405759
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 422 123
- Practice address
- 711 N Bridge Street
RM 122
Chippew Falls, WI 54729-1876 - Phone
- (715) 726-7788
- Fax
- (715) 726-4560
- NPI assigned
- Nov 17, 2006
- Last updated
- Jul 8, 2007
- Sex
- Female
- Sole proprietor
- No
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 | 422 123 | WI | Primary |
Addresses
Primary practice location
711 N Bridge Street
RM 122
Chippew Falls, WI 54729-1876
Mailing address
711 N Bridge Street
RM 122
Chippew Falls, WI 54729-1876
Phone (715) 726-7788
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 17950 | Other | WI | SECURITY HEALTH |
| 39576300 | Medicaid | WI |
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 |
|---|---|---|---|
| 422 123 | WI | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1163721600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1255405759",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "711 N BRIDGE STREET",
"address_2": "RM 122",
"city": "CHIPPEW FALLS",
"state": "WI",
"postal_code": "547291876",
"telephone_number": "715-726-7788",
"fax_number": "715-726-4560"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "711 N BRIDGE STREET",
"address_2": "RM 122",
"city": "CHIPPEW FALLS",
"state": "WI",
"postal_code": "547291876",
"telephone_number": "715-726-7788",
"fax_number": "715-726-4560"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KLINGER WALLOCH",
"first_name": "SUSAN",
"credential": "MSSW LCSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-11-17",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "WI",
"license": "422 123",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "SECURITY HEALTH",
"identifier": "17950",
"state": "WI"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "39576300",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Sources for this page
- 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.