Wanda Dannette Wallace, DSW, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

SW13939 Issued in FL

Practice address

9013 University Pkwy Ste C
Pensacola, FL 32514-9421

Phone

(850) 380-8320

Fax

(850) 478-7802

NPI assigned

Aug 12, 2019

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL, KY2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 2

Specialty

Clinical Social Worker

Education

Other, 2019

Medicare assignment

May accept Medicare assignment

Telehealth

Offers telehealth services

Group practices

Meridian Behavioral Health IncGroup PAC ID 6709149321, 17 clinicians

Stone Ridge Counseling Center IncGroup PAC ID 0840356127, 3 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Stone Ridge Counseling Center Inc

  • Mental Health Counselor
  • Pensacola, FL
  • NPI 1710134721

  Clinical

  Medicare reassignment Care Compare group NPD
• Meridian Behavioral Health, Inc

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Louisville, KY
  • NPI 1427569219
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1565568000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1566259200000",
    "number": "1043866411",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9013 UNIVERSITY PKWY STE C",
            "city": "PENSACOLA",
            "state": "FL",
            "postal_code": "325149421",
            "telephone_number": "850-380-8320",
            "fax_number": "850-478-7802"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9013 UNIVERSITY PKWY STE C",
            "city": "PENSACOLA",
            "state": "FL",
            "postal_code": "325149421",
            "telephone_number": "850-380-8320",
            "fax_number": "850-478-7802"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "WANDA",
        "middle_name": "DANNETTE",
        "name_prefix": "Dr.",
        "credential": "DSW, LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-08-12",
        "last_updated": "2019-08-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "FL",
            "license": "SW13939",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Will Pope Walker, M.D., PH.D.
• Deanthia Ricara-Gigi Wallace, APRN
• James P Wallace, PT
• Latoya M. Wallace, PA
• Victoria Wallace, LCSW
• Aaron C Wallender, DDS, MD
• Mary B Waller, CRNA
• Virginia Walls
• Jessica Lynn Walsh, FNP-C
• Vivian Rose Walsh

• Clinical Social Worker in Pensacola, FL
• Providers in Pensacola, FL by specialty
• Clinical Social Worker in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.