Isaac London Wanberg

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

9572110-3502 Issued in UT

Practice address

90 E 200 N
Logan, UT 84321-4034

Phone

(435) 750-0750

NPI assigned

Feb 24, 2011

Last updated

Sep 2, 2020By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in UT

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Social Worker

Education

Other, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Bear River Mental Health Services IncGroup PAC ID 0840102356, 31 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

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.

• Bear River Mental Health Services Inc

  • Mental Health Counselor
  • Logan, UT
  • NPI 1285736553
  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1298505600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1599004800000",
    "number": "1467759670",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "90 E 200 N",
            "city": "LOGAN",
            "state": "UT",
            "postal_code": "843214034",
            "telephone_number": "435-237-2301"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "90 E 200 N",
            "city": "LOGAN",
            "state": "UT",
            "postal_code": "843214034",
            "telephone_number": "435-750-0750"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WANBERG",
        "first_name": "ISAAC",
        "middle_name": "LONDON",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-02-24",
        "last_updated": "2020-09-02",
        "certification_date": "2020-08-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "UT",
            "license": "9572110-3503",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "UT",
            "license": "9572110-3502",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jacob Wallace, A.P.R.N
• Sarah Wallace, RDN
• Seth Browning Wallace, M.D.
• Walmart Inc. (WalMart Pharmacy 10-4272)
• Emma Louise Walton
• Rakelle J Wankier, OTR
• Garrett Ward
• Lily Ward
• Michael Jared Warde, CSW
• David G Waterman, MD

• Clinical Social Worker in Logan, UT
• Providers in Logan, UT by specialty
• Clinical Social Worker in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 2, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.