Active NPI
Shellie Waterman, LCSW
- Clinical Social Worker
- Chubbuck, ID
National Provider Identifier
1801335633
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- LCSW-35898
- Practice address
- 210 W Burnside Ave
Suite a
Chubbuck, ID 83202-4916 - Phone
- (208) 238-9000
- Fax
- (208) 238-9002
- NPI assigned
- Feb 13, 2017
- Last updated
- Feb 13, 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-35898 | ID | Primary |
Addresses
Primary practice location
210 W Burnside Ave
Suite a
Chubbuck, ID 83202-4916
Mailing address
210 W Burnside Ave
Suite a
Chubbuck, ID 83202-4916
Phone (208) 238-9000
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LCSW-35898 | ID | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1486944000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1486944000000",
"number": "1801335633",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "210 W BURNSIDE AVE",
"address_2": "SUITE A",
"city": "CHUBBUCK",
"state": "ID",
"postal_code": "832024916",
"telephone_number": "208-238-9000",
"fax_number": "208-238-9002"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "210 W BURNSIDE AVE",
"address_2": "SUITE A",
"city": "CHUBBUCK",
"state": "ID",
"postal_code": "832024916",
"telephone_number": "208-238-9000",
"fax_number": "208-238-9002"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WATERMAN",
"first_name": "SHELLIE",
"name_prefix": "Ms.",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-02-13",
"last_updated": "2017-02-13",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "ID",
"license": "LCSW-35898",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chubbuck, ID
- Walgreen Co (Walgreens #09157)
- Walmart Inc. (Walmart Pharmacy 10-1995)
- John Cole Warburton, PHARMD
- Wesley Ward
- Jerralyn R Wasylyshen, PT
- Alec Weaver
- Trilby M Wedler, NURSE PRACTITIONER
- Westmed Medical of Idaho, LLC
- Whitewater Healthcare LLC (Symbii Home Health)
- Whitewater Healthcare LLC (Symbii Hospice)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.