NPIMap

Organization Active NPI

One Heart Wild

  • Clinical Social Worker
  • Silverdale, WA
National Provider Identifier
1548750615
Registry record updated Nov 3, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
LICSW Issued in WA
Legal business name
ONE HEART WILD
Practice address
12620 Willamette Meridian Rd NW
Silverdale, WA 98383-9701
Phone
(360) 509-2948
Fax
(360) 337-7433
NPI assigned
May 15, 2018
Last updated
Nov 3, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 3, 2023

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

Authorized official

Name
Brenda Lee Newell, LICSWNPI 1033550272
Title
Clinical Director
Phone
(425) 280-6508

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X LICSW WA Primary

Addresses

Primary practice location

12620 Willamette Meridian Rd NW
Silverdale, WA 98383-9701

Mailing address

12620 Willamette Meridian Rd NW
Silverdale, WA 98383-9701
Phone (360) 509-2948

Other identifiers 1

IdentifierTypeStateIssuer
2083710MedicaidWA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1526342400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1698969600000",
    "number": "1548750615",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12620 WILLAMETTE MERIDIAN RD NW",
            "city": "SILVERDALE",
            "state": "WA",
            "postal_code": "983839701",
            "telephone_number": "360-509-2948",
            "fax_number": "360-337-7433"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12620 WILLAMETTE MERIDIAN RD NW",
            "city": "SILVERDALE",
            "state": "WA",
            "postal_code": "983839701",
            "telephone_number": "360-509-2948",
            "fax_number": "360-337-7433"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ONE HEART WILD",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-05-15",
        "last_updated": "2023-11-03",
        "certification_date": "2023-11-03",
        "status": "A",
        "authorized_official_last_name": "NEWELL",
        "authorized_official_first_name": "BRENDA",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "CLINICAL DIRECTOR",
        "authorized_official_telephone_number": "425-280-6508",
        "authorized_official_credential": "LICSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "WA",
            "license": "LICSW",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2083710",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Silverdale, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 3, 2023; 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.