NPIMap

Individual provider Active NPI

Olivia Estelle Ponce, MSW, CADC II

  • Clinical Social Worker
  • Suquamish, WA
National Provider Identifier
1952844615
Registry record updated Aug 3, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
Practice address
18490 Suquamish Way NE Unit 107
Suquamish, WA 98392-9533
Phone
(360) 394-8558
Fax
(360) 598-1724
NPI assigned
Nov 29, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 3, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) Counselor 101YA0400X 22-02-20139 OR
Clinical Social Worker 1041C0700X OR Primary
Addiction (Substance Use Disorder) Counselor 101YA0400X 16-08-26 OR

Addresses

Primary practice location

18490 Suquamish Way NE Unit 107
Suquamish, WA 98392-9533

Mailing address

1998 State Hwy 308
PO Box 174
NE Keyport, WA 98345-9997
Phone (541) 228-2852

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

Practice roles

OrganizationSpecialtyStatusNew patients
Suquamish Tribal Addiction (Substance Use Disorder) CurrentSince Aug 7, 2022 Accepting new patients
Benton County Past Accepting new patients
Suquamish Tribal PastSince Aug 7, 2022 Accepting new patients
Family Recovery Non-Profit, Inc. Past Accepting new patients

Locations

18490 Suquamish Way NE
Unit 107
Suquamish, WA 98392
Phone (360) 394-8550

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1480377600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1659484800000",
    "number": "1952844615",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1998 STATE HWY 308",
            "address_2": "PO BOX 174",
            "city": "NE KEYPORT",
            "state": "WA",
            "postal_code": "983459997",
            "telephone_number": "541-228-2852"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18490 SUQUAMISH WAY NE UNIT 107",
            "city": "SUQUAMISH",
            "state": "WA",
            "postal_code": "983929533",
            "telephone_number": "360-394-8558",
            "fax_number": "360-598-1724"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PONCE",
        "first_name": "OLIVIA",
        "middle_name": "ESTELLE",
        "credential": "MSW, CADC II",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-11-29",
        "last_updated": "2022-08-03",
        "certification_date": "2022-08-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "OR",
            "license": "22-02-20139",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OR",
            "license": null,
            "primary": true
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "OR",
            "license": "16-08-26",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Suquamish, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 2022; 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.