Healthcare Provider Details

I. General information

NPI: 1083016042
Provider Name (Legal Business Name): MICHELLE I CARDENAS MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MICHELLE SALAZAR

II. Dates (important events)

Enumeration Date: 09/22/2014
Last Update Date: 08/08/2025
Certification Date: 08/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122 N WILBUR AVE
WALLA WALLA WA
99362-2548
US

IV. Provider business mailing address

122 N WILBUR AVE
WALLA WALLA WA
99362-2548
US

V. Phone/Fax

Practice location:
  • Phone: 509-200-0666
  • Fax:
Mailing address:
  • Phone: 509-200-0666
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLW60997511
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: