Active NPI
Melinda Gayle Boonstra
- Clinical Social Worker
- Marysville, WA
National Provider Identifier
1740530724
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- LW61279465
- Practice address
- 4308 76TH St NE
Marysville, WA 98270-3720 - Phone
- (425) 349-7352
- NPI assigned
- Sep 17, 2012
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | LW61279465 | WA | Primary |
| Social Worker | 104100000X |
Addresses
Primary practice location
4308 76TH St NE
Marysville, WA 98270-3720
Mailing address
PO Box 3810
Everett, WA 98213
Phone (425) 349-8359
Other practice location 1
835 E Fairhaven Ave
Burlington, WA 98233-1916
Phone (360) 856-7960
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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20220826002155 | WA | Practitioner - Clinical Social Worker | 5395129258 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Compass Health | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Community/Behavioral Health Agency
- Everett, WA
- NPI 1730136201
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1347840000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1660176000000",
"number": "1740530724",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 3810",
"city": "EVERETT",
"state": "WA",
"postal_code": "98213",
"telephone_number": "425-349-8359"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4308 76TH ST NE",
"city": "MARYSVILLE",
"state": "WA",
"postal_code": "982703720",
"telephone_number": "425-349-7352"
}
],
"practiceLocations": [
{
"address_1": "835 E Fairhaven Ave",
"address_purpose": "LOCATION",
"city": "Burlington",
"state": "WA",
"postal_code": "982331916",
"country_code": "US",
"telephone_number": "360-856-7960",
"fax_number": "360-755-1405",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "BOONSTRA",
"first_name": "MELINDA",
"middle_name": "GAYLE",
"name_prefix": "Mrs.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-09-17",
"last_updated": "2022-08-11",
"certification_date": "2022-08-11",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "WA",
"license": "LW61279465",
"primary": true
},
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Marysville, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2022; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.