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

Shauntae Willis, LICSW, CDP

Individual provider Clinical Social Worker · NPI 1790938355

Shauntae Willis, LICSW, CDP is a Clinical Social Worker in Seattle, Washington. Qualified in 2003, 23 years ago. Practices with Kaiser Foundation Health Plan of Washington, a 1,519-clinician group, works from 2 locations and accepts Medicare assignment. Licensed in Washington.

Years since qualifying
23
Licensed in
WA
In the registry since
2008
Specialties on file
2
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

901 Boren Ave SUITE1300
Seattle, WA 98104-3595
Phone: (206) 619-0028
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 1400 Pottery Ave, Port Orchard, WA 98366-3711 — (360) 895-5000

Specialties & licences

Clinical Social Worker (primary) Taxonomy 1041C0700X · Licence LW 60003495 (WA)
Addiction (Substance Use Disorder) Counselor Taxonomy 101YA0400X · Licence CP 00005642 (WA)

Record details

NPI number1790938355
Entity typeIndividual (Type 1)
GenderFemale
Credentials LICSW , CDP
Sole proprietorYes
NPI enumeratedOctober 28, 2008
Last updated in NPPESJune 22, 2021
Certification dateJune 22, 2021

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)
Group practice Kaiser Foundation Health Plan Of Washington — 1519 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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