Barbara J Wallace, LICSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

LW00005711 Issued in WA

Practice address

1007 Koala Dr.
Omak, WA 98841

Phone

(509) 826-6191

Fax

(509) 826-8416

NPI assigned

Oct 24, 2014

Sex

Female

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

Practice roles

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.

• Mindcare Solutions of Texas PA

  • Psychiatry Physician
  • Austin, TX
  • NPI 1396290730
  NPD (past)

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

{
    "created_epoch": "1414108800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1414108800000",
    "number": "1255736955",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1007 KOALA DR.",
            "city": "OMAK",
            "state": "WA",
            "postal_code": "98841",
            "telephone_number": "509-826-6191",
            "fax_number": "509-826-8416"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1007 KOALA DR.",
            "city": "OMAK",
            "state": "WA",
            "postal_code": "98841",
            "telephone_number": "509-826-6191",
            "fax_number": "509-826-8416"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "BARBARA",
        "middle_name": "J",
        "credential": "LICSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-10-24",
        "last_updated": "2014-10-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "WA",
            "license": "LW00005711",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Abraham Velasco Bustamante, PA
• Blair Noel Velez-Kelsey, MHCP
• Wal-Mart Stores Inc (Vision Center 30-1947)
• Shelly M Waldern, ARNP FNP-BC
• Katie Renee Walker, MSW
• Adam John Wallenta, PA-C
• Walmart Inc. (Walmart Pharmacy 10-1947)
• Washington Em-I Medical Services PC
• J. R. Craig Webster, D.D.S.
• Xu Wei, ARNP

• Clinical Social Worker in Omak, WA
• Providers in Omak, WA by specialty
• Clinical Social Worker in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2014; 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.