Carl Landerholm, LICSW is a medicare enrolled "Social Worker - Clinical" provider in Aberdeen, Washington. His current practice location is
2700 Simpson Ave Ste 101, Aberdeen, Washington. You can reach out to his office (for appointments etc.) via phone at
(360) 906-0228.
Carl Landerholm is licensed to practice in Washington (license number LW60140440) and he also participates in the medicare program. He does not accept medicare assignments directly but he may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. His NPI Number is 1194140228.
Healthcare Provider's Profile
| Full Name | Carl Landerholm |
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| Gender | Male |
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| Speciality | Social Worker - Clinical |
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| Location | 2700 Simpson Ave Ste 101, Aberdeen, Washington |
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| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
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NPI Data:
- NPI Number: 1194140228
- Provider Enumeration Date: 02/26/2014
- Last Update Date: 11/01/2019
Medicare PECOS Information:
- PECOS PAC ID: 5890012272
- Enrollment ID: I20150618001533
Medical Identifiers
Medical identifiers for Carl Landerholm such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1194140228 | NPI | - | NPPES |
| 2129981 | Medicaid | WA | |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 101Y00000X | Counselor | (* (Not Available)) | Secondary |
| 1041C0700X | Social Worker - Clinical | LW60140440 (Washington) | Primary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Carl Landerholm is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Carl Landerholm, LICSW
Po Box 1847,
Longview, WA 98632-8140
Ph: (360) 423-0203 | Carl Landerholm, LICSW
2700 Simpson Ave Ste 101,
Aberdeen, WA 98520-4333
Ph: (360) 906-0228 |
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