Kendall Todd Carman-Wagner, LICSW

Key facts

NPI

1962552844

Entity type

Individual (NPI type 1)

Primary specialty

Clinical Social Worker 1041C0700X

License

LW00005301 (WA)

Practice address

1012 S 3Rd St
Dayton, WA 99328-1606

Phone

(509) 382-2531

NPI assigned

Jan 11, 2007

Sex

Male

Sole proprietor

No

Organizations & group practices 7

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.

• Columbia County Hospital District Critical Access Hospital · Dayton, WA · NPI 1134128911
  Medicare reassignment Care Compare group NPD WA
• Columbia County Hospital District Rural Health Clinic/Center · Waitsburg, WA · NPI 1215018346
  Care Compare group NPD
• Columbia County Hospital District Rural Health Clinic/Center · Dayton, WA · NPI 1518044551
  Care Compare group NPD (past)
• Columbia County Hospital District Skilled Nursing Facility · Dayton, WA · NPI 1659458610
  Care Compare group
• Columbia County Hospital District Medicare Defined Swing Bed Hospital Unit · Dayton, WA · NPI 1932286077
  Care Compare group
• Columbia County Hospital District Primary Care Clinic/Center · College Place, WA · NPI 1851050264
  NPD
• Jubilee Leadership Academy Community/Behavioral Health Agency · Prescott, WA · NPI 1477940419
  NPD (past)

Medicare Care Compare profile

Specialty

Clinical Social Worker

Education

Other, 1990

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Columbia County Hospital District (55 clinicians)

Practice addresses (Care Compare)

Medicare participation

Medicare fee-for-service enrollment

Enrolled in WA

Eligible to order & refer

Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No

Medicare enrollment records

National Provider Directory

Medicare enrollment (NPD)

Yes

State licenses

Practice roles

Locations

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Feb 15, 2024.

{
    "created_epoch": "1168473600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1707955200000",
    "number": "1962552844",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "350 EQUESTRIAN WAY",
            "city": "WALLA WALLA",
            "state": "WA",
            "postal_code": "993626220",
            "telephone_number": "509-529-1496"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1012 S 3RD ST",
            "city": "DAYTON",
            "state": "WA",
            "postal_code": "993281606",
            "telephone_number": "509-382-2531"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "29 Jubilee Cir",
            "address_purpose": "LOCATION",
            "city": "Prescott",
            "state": "WA",
            "postal_code": "993488607",
            "country_code": "US",
            "telephone_number": "509-749-2103 x252",
            "fax_number": "509-749-2076",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CARMAN-WAGNER",
        "first_name": "KENDALL",
        "middle_name": "TODD",
        "credential": "LICSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-11",
        "last_updated": "2024-02-15",
        "certification_date": "2024-02-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "WA",
            "license": "LW00005301",
            "primary": true
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "WA",
            "license": "CP00000091",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dayton, WA

• April R Biggs, MD
• Blue Mountain Counseling
• Blue Mountain Counseling of Columbia County
• Julia Grace Bruce, MSN, RDN, CD
• Jennifer Lea Burnett, NP
• Kathleen A Casseday, ARNP
• Chrisann T Christensen, LMHC
• Sherena Gwenevere Clements, RN
• Columbia County Fire Dist 3
• Columbia County Hospital District

All providers in Dayton, WA · Clinical Social Worker in Washington