Gretchen Coleman Wallace, MS, RD, LD, CD

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

DI60956654 Issued in WA

Practice address

6 Cardinal Way
Suite 900
St. Louis, MO 63102

Phone

(360) 209-2075

Fax

(206) 681-9640

NPI assigned

Aug 25, 2017

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 4

Addresses

Other names 1

• Gretchen Marie Coleman Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1503619200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1699401600000",
    "number": "1023535440",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6 CARDINAL WAY STE 900",
            "city": "ST. LOUIS",
            "state": "MO",
            "postal_code": "63102",
            "telephone_number": "360-209-2075",
            "fax_number": "206-681-9640"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6 CARDINAL WAY",
            "address_2": "SUITE 900",
            "city": "ST. LOUIS",
            "state": "MO",
            "postal_code": "63102",
            "telephone_number": "360-209-2075",
            "fax_number": "206-681-9640"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "GRETCHEN",
        "middle_name": "COLEMAN",
        "name_prefix": "Mrs.",
        "credential": "MS, RD, LD, CD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-08-25",
        "last_updated": "2023-11-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "MO",
            "license": "2023005984",
            "primary": false
        },
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "OR",
            "license": "10235828",
            "primary": false
        },
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "WA",
            "license": "DI60956654",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "GRETCHEN",
            "last_name": "COLEMAN",
            "middle_name": "MARIE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Claire Wallace, PH.D.
• Colleen Maire Wallace, MD
• Darcie L Wallace, PA-C
• Erin Wallace
• Francene Wallace
• Jacob Henry Wallace, MD
• James Wallace, MA, THM, STM
• Jorge Wallace, PLPC
• Joslyn Wallace
• Kaila Wallace, DOULA

• Registered Dietitian in St. Louis, MO
• Providers in St. Louis, MO by specialty
• Registered Dietitian in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.