Individual provider Active NPI

Tasha Willoughby

  • Social Worker
  • Walla Walla, WA
National Provider Identifier
1619454030
Registry record updated Feb 19, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Social WorkerTaxonomy code 104100000X
License
LW60761649 Issued in WA
Practice address
1120 W Rose St
Walla Walla, WA 99362-1662
Phone
(509) 525-6650
Fax
(509) 522-2349
NPI assigned
Jul 27, 2018
Last updated
Feb 19, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 19, 2021

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) Counselor 101YA0400X 60472656 WA
Social Worker 104100000X
Social Worker 104100000X LW60761649 WA Primary

Addresses

Primary practice location

1120 W Rose St
Walla Walla, WA 99362-1662

Mailing address

1120 W Rose St
Walla Walla, WA 99362-1662
Phone (509) 525-6650

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
Eligible to order & refer
  • Part B services: No
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190213000937 WA Practitioner - Clinical Social Worker 0042558298 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
60472656WAMDAddiction (Substance Use Disorder) Counselor
LW60761649WAMDSocial Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Yakima Valley Farm Workers Clinic CurrentSince Jan 28, 2021 Accepting new patients
Yakima Valley Farm Workers Clinic CurrentSince Jan 28, 2021 Accepting new patients

Locations

1608 Road 44
Pasco, WA 99301
Phone (509) 543-9280

713 Memorial St
Prosser, WA 99350
Phone (509) 786-1931

1120 W Rose St
Walla Walla, WA 99362
Phone (509) 525-6650

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1532649600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1613692800000",
    "number": "1619454030",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1120 W ROSE ST",
            "city": "WALLA WALLA",
            "state": "WA",
            "postal_code": "993621662",
            "telephone_number": "509-525-6650",
            "fax_number": "509-522-2349"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1120 W ROSE ST",
            "city": "WALLA WALLA",
            "state": "WA",
            "postal_code": "993621662",
            "telephone_number": "509-525-6650",
            "fax_number": "509-522-2349"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLOUGHBY",
        "first_name": "TASHA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-07-27",
        "last_updated": "2021-02-19",
        "certification_date": "2021-02-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "WA",
            "license": "60472656",
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "WA",
            "license": "LW60761649",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Walla Walla, WA

Sources for this page

Verify at the official NPI Registry.