Breanne Wallin

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

ISW15020 Issued in FL

Practice address

2140 N Don Wickham Dr
Clermont, FL 34711-1923

Phone

(352) 394-5922

NPI assigned

Feb 26, 2021

Sex

Female

Sole proprietor

Yes

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not 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.

• Lifestream Behavioral Center Inc

  • Primary Care Clinic/Center
  • Leesburg, FL
  • NPI 1659613776
  NPD (past)
• Lifestream Behavioral Center Inc

  • Psychiatric Hospital
  • Leesburg, FL
  • NPI 1902802002
  NPD (past)

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

{
    "created_epoch": "1614297600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1614297600000",
    "number": "1821682121",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 491000",
            "city": "LEESBURG",
            "state": "FL",
            "postal_code": "347491000",
            "telephone_number": "352-315-7531",
            "fax_number": "352-315-7587"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2140 N DON WICKHAM DR",
            "city": "CLERMONT",
            "state": "FL",
            "postal_code": "347111923",
            "telephone_number": "352-394-5922"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLIN",
        "first_name": "BREANNE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-02-26",
        "last_updated": "2021-02-26",
        "certification_date": "2021-02-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "FL",
            "license": "ISW15020",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Faith Walker, COTA/L
• Karrie A Walker
• Latisha Walker
• Lindsey Dawn Walker
• Sharon A Walker, ARNP
• Suzanne Wallis, FNP-BC
• Tyler Demetri Walsh-James, COTA/L
• Andrew Lawrence Walsh, A.P. ACUPUNCTURE
• Brian Patrick Walsh, PTA
• Kaitlin Walsh, OTR/L

• Clinical Social Worker in Clermont, FL
• Providers in Clermont, FL by specialty
• Clinical Social Worker in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 26, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.