Active NPI
Susan Dale Wall, LCSW
- Clinical Social Worker
- Flagstaff, AZ
National Provider Identifier
1740728088
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- LCSW - 2625
- Practice address
- 77 W Forest Ave
Suite 202
Flagstaff, AZ 86001-1479 - Phone
- (928) 773-2249
- Fax
- (928) 214-3981
- NPI assigned
- Feb 7, 2017
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | LCSW - 2625 | AZ | Primary |
Addresses
Primary practice location
77 W Forest Ave
Suite 202
Flagstaff, AZ 86001-1479
Mailing address
1200 N Beaver St
Flagstaff, AZ 86001-3118
Phone (928) 213-6235
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LCSW - 2625 | AZ | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1486425600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1488326400000",
"number": "1740728088",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1200 N BEAVER ST",
"city": "FLAGSTAFF",
"state": "AZ",
"postal_code": "860013118",
"telephone_number": "928-213-6235",
"fax_number": "928-213-6292"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "77 W FOREST AVE",
"address_2": "SUITE 202",
"city": "FLAGSTAFF",
"state": "AZ",
"postal_code": "860011479",
"telephone_number": "928-773-2249",
"fax_number": "928-214-3981"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALL",
"first_name": "SUSAN",
"middle_name": "DALE",
"name_prefix": "Ms.",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-02-07",
"last_updated": "2017-03-01",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "AZ",
"license": "LCSW - 2625",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Flagstaff, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 1, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.