Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Cynthia Wallace, LICSW

Individual provider Clinical Social Worker · NPI 1093075913

Cynthia Wallace, LICSW is a Clinical Social Worker in Walla Walla, Washington. Qualified in 2003, 23 years ago. Practices as a sole proprietor and accepts Medicare assignment. Licensed in Washington.

Years since qualifying
23
Licensed in
WA
In the registry since
2012
What do these letters mean?
LICSW — Licensed Independent Clinical Social Worker
The title some states use for an independently practising clinical social worker.

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Practice location Address checks out

19 E Birch St Ste 103
Walla Walla, WA 99362-3084
Phone: (509) 200-7290
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Clinical Social Worker (primary) Taxonomy 1041C0700X · Licence LW00009476 (WA)

Record details

NPI number1093075913
Entity typeIndividual (Type 1)
GenderFemale
Credentials LICSW
Sole proprietorYes
NPI enumeratedMay 24, 2012
Last updated in NPPESMay 24, 2012
Mailing address553 Locust St, Walla Walla, WA 99362-3338

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyCLINICAL SOCIAL WORKER
Medical schoolOTHER
Graduated 2003 (23 years in practice)
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

Other providers in Walla Walla