Tasha Lynn Wisdom, LCSW
Individual provider Active NPI Clinical Social Worker · Ellington, MO
NPI 1730450156 · NPPES record last updated Oct 30, 2023
Key facts
- NPI
- 1730450156
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- 2014018308 (MO)
- Practice address
- 315 E Walnut St
Ellington, MO 63638 - Phone
- (573) 663-2644
- NPI assigned
- Jan 17, 2012
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 4
Medicare Care Compare profile
- Specialty
- Clinical Social Worker
- Education
- Other, 2011
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Family Counseling Center Inc
Practice addresses (Care Compare)
3001 Warrior LN
Poplar Bluff, MO 63901-8685
Phone (573) 686-1200
3025 Warrior Lane
Poplar Bluff, MO 63901-8685
Phone (573) 686-1200
925 Hwy VV
Kennett, MO 63857-0071
Phone (573) 888-5925
BLDG 925 Hwy VV
Kennett, MO 63857-0071
Phone (573) 888-5925
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MO
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150331002659 | MO | Practitioner - Clinical Social Worker | 6608193651 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Family Counseling Center, Inc. | Current |
Accepting new patients | |
| Family Counseling Center, Inc. | Current |
Accepting new patients | |
| Iron County Hospital District | Current | Accepting new patients | |
| Skaggzzz Sleep Institute, Inc. | Past |
Accepting new patients |
Locations
315 E Walnut St
Ellington, MO 63638
Phone (573) 663-2500
3001 Warrior Ln
Poplar Bluff, MO 63901
Phone (573) 785-7453
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 2014018308 | MO | Yes |
Addresses
Primary practice location
315 E Walnut St
Ellington, MO 63638
Mailing address
315 E Walnut St
Ellington, MO 63638-7943
Phone (573) 663-2644
Other providers in Ellington, MO
All providers in Ellington, MO · Clinical Social Worker in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 30, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.