Tara Waller

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

0904016744 Issued in VA

Practice address

1454 Mexico Way NE
Roanoke, VA 24012-6476

Phone

(434) 533-1088

Fax

(434) 664-1177

NPI assigned

Apr 25, 2024

Last updated

Apr 25, 2024By the provider in NPPES

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

Opted out of Medicare

Previously, effective Sep 26, 2024 through Sep 26, 2026

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

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  NPD (past)
• Shenandoah Psychological Services, LLC

  • Clinical Psychologist
  • Harrisonburg, VA
  • NPI 1851717078
  NPD (past)

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

{
    "created_epoch": "1714003200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1714003200000",
    "number": "1467208918",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "724 SHELBOURNE AVE",
            "city": "VINTON",
            "state": "VA",
            "postal_code": "241793720",
            "telephone_number": "304-747-8587"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1454 MEXICO WAY NE",
            "city": "ROANOKE",
            "state": "VA",
            "postal_code": "240126476",
            "telephone_number": "434-533-1088",
            "fax_number": "434-664-1177"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLER",
        "first_name": "TARA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-04-25",
        "last_updated": "2024-04-25",
        "certification_date": "2024-04-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "VA",
            "license": "0904016744",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Whitney Walker
• Whitney Erin Gendron Walker, LPC
• Dorian Wallace, OT/R
• Ashley Mariah Wallen
• Dominique Waller
• Melissa Walls, PHARMD
• Walnut Avenue Associates PC
• Sonnie C Walsh, LPTA
• Walter B. Blair,M.D., Inc
• Walter Chiropractic Clinic

• Clinical Social Worker in Roanoke, VA
• Providers in Roanoke, VA by specialty
• Clinical Social Worker in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 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.

Verify at the official NPI Registry.