Tessa Waterbury Wallace, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

LW60171285 Issued in WA

Practice address

65371 Hwy 14
White Salmon, WA 98672-9867

Phone

(509) 493-2133

NPI assigned

Mar 31, 2009

Last updated

Jan 13, 2025By 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 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in WA

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, 2003

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

One Community HealthGroup PAC ID 6305759283, 51 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• One Community Health

  • Federally Qualified Health Center (FQHC)
  • White Salmon, WA
  • NPI 1376221259
  Medicare reassignment Care Compare group NPD
• One Community Health

  • Community/Retail Pharmacy
  • The Dalles, OR
  • NPI 1104666064
  NPD

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

{
    "created_epoch": "1238457600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1736726400000",
    "number": "1578705950",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "849 PACIFIC AVE",
            "city": "HOOD RIVER",
            "state": "OR",
            "postal_code": "970311956"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "65371 HWY 14",
            "city": "WHITE SALMON",
            "state": "WA",
            "postal_code": "986729867",
            "telephone_number": "509-493-2133"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1620 E 12th St",
            "address_purpose": "LOCATION",
            "city": "The Dalles",
            "state": "OR",
            "postal_code": "97058",
            "country_code": "US",
            "telephone_number": "541-296-9151",
            "fax_number": "541-296-9156",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WATERBURY WALLACE",
        "first_name": "TESSA",
        "name_prefix": "Mrs.",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-03-31",
        "last_updated": "2025-01-13",
        "certification_date": "2025-01-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OR",
            "license": "L4499",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "WA",
            "license": "LW60171285",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2014480",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "218112",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Trinity Natural Medicine, LLC. (White Salmon Apothecary)
• Michelle Ubell, L AC
• Chardonnay Vance, MD PHD
• W. Curtis Mathisen D.D.S.
• Brittney K Wangelin
• Miranda Welch, D.A.O.M, L.AC,
• Wellness LLC
• White Salmon Acupuncture LLP
• White Salmon Family Practice Clinic
• White Salmon Valley School District

• Clinical Social Worker in White Salmon, WA
• Providers in White Salmon, WA by specialty
• Clinical Social Worker in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2025; 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.