Tasha Lynn Wisdom, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

2014018308 Issued in MO

Practice address

315 E Walnut St
Ellington, MO 63638

Phone

(573) 663-2644

NPI assigned

Jan 17, 2012

Last updated

Oct 30, 2023By 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 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MO

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, 2011

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Family Counseling Center IncGroup PAC ID 2163410481, 39 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

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.

• Family Counseling Center, Inc.

  • Community/Behavioral Health Agency
  • Kennett, MO
  • NPI 1669477550
  Medicare reassignment Care Compare group NPD
• Iron County Hospital District

  dba Iron County Medical Center

  • Critical Access Hospital
  • Pilot Knob, MO
  • NPI 1477648178
  Medicare reassignment NPD
• Family Counseling Center, Inc.

  dba FCC Primary Care

  • Primary Care Clinic/Center
  • Poplar Bluff, MO
  • NPI 1235738493
  NPD
• Skaggzzz Sleep Institute, Inc.

  • Physiological Laboratory
  • Farmington, MO
  • NPI 1306863246
  NPD (past)

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

{
    "created_epoch": "1326758400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698624000000",
    "number": "1730450156",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "315 E WALNUT ST",
            "city": "ELLINGTON",
            "state": "MO",
            "postal_code": "636387943",
            "telephone_number": "573-663-2644"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "315 E WALNUT ST",
            "city": "ELLINGTON",
            "state": "MO",
            "postal_code": "63638",
            "telephone_number": "573-663-2644"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WISDOM",
        "first_name": "TASHA",
        "middle_name": "LYNN",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-01-17",
        "last_updated": "2023-10-30",
        "certification_date": "2023-10-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MO",
            "license": "2014018308",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Southern Reynolds Rii
• Joyce Anne Stout
• Kelsi Leah Ann Vickers
• Evelyn D Walberg
• Cheryl Renee White

• Clinical Social Worker in Ellington, MO
• Providers in Ellington, MO by specialty
• Clinical Social Worker in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2023; 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.