Active NPI
Vanessa Wall
- Clinical Psychologist
- Seattle, WA
National Provider Identifier
1356175111
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 61506775
- Practice address
- 4746 44TH Ave SW Ste 202
Seattle, WA 98116-4476 - Phone
- (719) 332-7451
- NPI assigned
- Aug 26, 2024
- 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 Psychologist | 103TC0700X | 61506775 | WA | Primary |
Addresses
Primary practice location
4746 44TH Ave SW Ste 202
Seattle, WA 98116-4476
Mailing address
4746 44TH Ave SW Ste 202
Seattle, WA 98116-4476
Phone (719) 332-7451
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Dec 19, 2024 through Dec 19, 2026
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 61506775 | WA | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1724630400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1724630400000",
"number": "1356175111",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4746 44TH AVE SW STE 202",
"city": "SEATTLE",
"state": "WA",
"postal_code": "981164476",
"telephone_number": "719-332-7451"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4746 44TH AVE SW STE 202",
"city": "SEATTLE",
"state": "WA",
"postal_code": "981164476",
"telephone_number": "719-332-7451"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALL",
"first_name": "VANESSA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2024-08-26",
"last_updated": "2024-08-26",
"certification_date": "2024-08-26",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "WA",
"license": "61506775",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Seattle, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.