Stacie Crochet

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

LW60514575 Issued in WA

Practice address

339 Bozarth Ave
Woodland, WA 98674-8424

Phone

(512) 921-5925

NPI assigned

Jul 31, 2006

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Other names 1

• Stacie McKenna Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Oct 1, 2018 through Oct 1, 2026

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

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  • NPI 1013452663
  NPD (past)

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

{
    "created_epoch": "1154304000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1484956800000",
    "number": "1740295153",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4949 LEWIS RIVER RD",
            "city": "WOODLAND",
            "state": "WA",
            "postal_code": "986749305",
            "telephone_number": "512-921-5925"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "339 BOZARTH AVE",
            "city": "WOODLAND",
            "state": "WA",
            "postal_code": "986748424",
            "telephone_number": "512-921-5925"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CROCHET",
        "first_name": "STACIE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-07-31",
        "last_updated": "2017-01-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "TX",
            "license": "22050",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "WA",
            "license": "LW60514575",
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OR",
            "license": "L6518",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "STACIE",
            "last_name": "MCKENNA",
            "credential": "LCSW",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Doina Mihaela Charan, DDS
• Jonathan M Cohen, ED. D, ATC, CSCS
• Contact Wellness LLC
• Cowlitz County Fire District 1
• Cowlitz Family Health Center
• Jay Scott Dawson, D.C.
• Carolyn Defoe
• Jodi L Denison, RPH
• Laura Margaret Dodge-Loney, LMP, LMT, NCTMB
• Hayley Ann Drake, LMP

• Clinical Social Worker in Woodland, WA
• Providers in Woodland, 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 21, 2017; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.