Active NPI
Terry Denise Banta, CSWA
- Clinical Social Worker
- Salem, OR
National Provider Identifier
1386280352
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- A4255
- Practice address
- 2460 4TH St NE
Salem, OR 97301-8332 - Phone
- (623) 866-9360
- NPI assigned
- Nov 25, 2019
- 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 | A4255 | OR | Primary |
Addresses
Primary practice location
2460 4TH St NE
Salem, OR 97301-8332
Mailing address
2460 4TH St NE
Salem, OR 97301-8332
Phone (623) 866-9360
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| A4255 | OR | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Blue Iris River Counseling LLC | Clinical | Current | 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": "1574640000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1634774400000",
"number": "1386280352",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2460 4TH ST NE",
"city": "SALEM",
"state": "OR",
"postal_code": "973018332",
"telephone_number": "623-866-9360"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2460 4TH ST NE",
"city": "SALEM",
"state": "OR",
"postal_code": "973018332",
"telephone_number": "623-866-9360"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BANTA",
"first_name": "TERRY",
"middle_name": "DENISE",
"name_prefix": "Ms.",
"credential": "CSWA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-11-25",
"last_updated": "2021-10-21",
"certification_date": "2021-10-21",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "OR",
"license": "A4255",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Salem, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 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.