Meredith Ann Waller, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

CSW.09925874 Issued in CO

Practice address

1755 48TH St Ste 200
Boulder, CO 80301-2712

Phone

(303) 415-7450

Fax

(303) 494-5265

NPI assigned

Jul 5, 2019

Last updated

Jul 5, 2019By the provider in NPPES

Sex

Female

Sole proprietor

No

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)

Enrolled

State licenses

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

{
    "created_epoch": "1562284800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1562284800000",
    "number": "1992367395",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5450 WESTERN AVE",
            "city": "BOULDER",
            "state": "CO",
            "postal_code": "803012709",
            "telephone_number": "303-415-7450",
            "fax_number": "303-494-5265"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1755 48TH ST STE 200",
            "city": "BOULDER",
            "state": "CO",
            "postal_code": "803012712",
            "telephone_number": "303-415-7450",
            "fax_number": "303-494-5265"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLER",
        "first_name": "MEREDITH",
        "middle_name": "ANN",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-07-05",
        "last_updated": "2019-07-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CO",
            "license": "CSW.09925874",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mary Louise Wallace, MA, CCC-SLP
• Tereasa Anne Wallace, RN, MN
• Cathrine Skogheim Walle, D.C., B.S.
• Katherine Eleanor Waller
• Lauren Alexandra Waller, LCSW
• Ruth Stephanie Waller, P.T.
• Leah Wallerstein, M.A.
• Sean Wallis, NP
• Lucas Bryant Walljasper
• Carol M Wallman

• Clinical Social Worker in Boulder, CO
• Providers in Boulder, CO by specialty
• Clinical Social Worker in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 5, 2019; 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.