STACEY TIDWELL LCSW NPI 1790189413

NPI Information

NPI: 1790189413
Provider Name: STACEY TIDWELL, LCSW
Classification: Social Worker - 1041S0200X
Entity Type: Individual

Specialization: School

PECOS Registration: Yes

Address:
3311 MORADA LN
STOCKTON, CA
ZIP 95212
Phone: (209) 647-3047
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Stacey Tidwell, LCSW is a school social worker in Stockton, CA with 8 years of experience. Stacey Tidwell, LCSW NPI is 1790189413. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

3311 MORADA LN
STOCKTON, CA
ZIP 95212-148
Phone: (209) 647-3047

The NPI 1790189413 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment.

The enumeration date for this NPI number is 10/9/2014 and was last updated on 12/30/2021.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	1041S0200X	Social Worker	School			Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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