Active NPI
Candice Stark Vallejo, LISW
- Clinical Social Worker
- Council Bluffs, IA
National Provider Identifier
1891030649
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 00442
- Practice address
- 300 W Broadway Ste 29
Council Bluffs, IA 51503-9030 - Phone
- (712) 323-1660
- NPI assigned
- Dec 5, 2012
- Last updated
- Dec 5, 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 00442 | IA | Primary |
Addresses
Primary practice location
300 W Broadway Ste 29
Council Bluffs, IA 51503-9030
Mailing address
300 W Broadway Ste 29
Council Bluffs, IA 51503-9030
Phone (712) 323-1660
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)
- Not enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Family Access Center, Inc. | Clinical | Past | Accepting new patients |
| Family Access Center | Clinical | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Community/Behavioral Health Agency
- Sioux City, IA
- NPI 1033280326
Clinical
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1354665600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1354665600000",
"number": "1891030649",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "300 W BROADWAY STE 29",
"city": "COUNCIL BLUFFS",
"state": "IA",
"postal_code": "515039030",
"telephone_number": "712-323-1660"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "300 W BROADWAY STE 29",
"city": "COUNCIL BLUFFS",
"state": "IA",
"postal_code": "515039030",
"telephone_number": "712-323-1660"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VALLEJO",
"first_name": "CANDICE",
"middle_name": "STARK",
"credential": "LISW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-12-05",
"last_updated": "2012-12-05",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "IA",
"license": "00442",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Council Bluffs, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.