Samantha Wall, GC-C, LMSW, CSWA

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

A16290 Issued in OR

Practice address

808 4TH St
Tillamook, OR 97141-3412

Phone

(925) 212-2865

NPI assigned

Dec 13, 2024

Sex

Female

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1734048000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1743379200000",
    "number": "1548077530",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "808 4TH ST",
            "city": "TILLAMOOK",
            "state": "OR",
            "postal_code": "971413412",
            "telephone_number": "925-212-2865"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "808 4TH ST",
            "city": "TILLAMOOK",
            "state": "OR",
            "postal_code": "971413412",
            "telephone_number": "925-212-2865"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALL",
        "first_name": "SAMANTHA",
        "credential": "GC-C, LMSW, CSWA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-12-13",
        "last_updated": "2025-03-31",
        "certification_date": "2025-03-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "OR",
            "license": "M15889",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OR",
            "license": "A16290",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michael John Veverka, M.D.
• Jamie Helene Villemonte, LCSW
• Tami Rennels Waddell, LCSW
• Dennis S Wagner, DMD
• David Walker, RPH
• Kaylynn Walls, RDH
• Erin L Warbington, RN
• Matthew S Waxter, DC
• Paul C Welch, M.D.
• Western Health Resources

• Clinical Social Worker in Tillamook, OR
• Providers in Tillamook, OR by specialty
• Clinical Social Worker in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 31, 2025; 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.