Active NPI
Catherine Jessica Wallace
- Clinical Psychologist
- Sherman Oaks, CA
National Provider Identifier
1083130827
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 34791
- Practice address
- 13130 Burbank Blvd
Sherman Oaks, CA 91401-6037 - Phone
- (818) 731-0360
- NPI assigned
- Aug 14, 2017
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 34791 | CA | Primary |
Addresses
Primary practice location
13130 Burbank Blvd
Sherman Oaks, CA 91401-6037
Mailing address
4001 State Hwy 104
Ione, CA 95640
Phone (209) 274-4911
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1502668800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1723507200000",
"number": "1083130827",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4001 STATE HWY 104",
"city": "IONE",
"state": "CA",
"postal_code": "95640",
"telephone_number": "209-274-4911"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "13130 BURBANK BLVD",
"city": "SHERMAN OAKS",
"state": "CA",
"postal_code": "914016037",
"telephone_number": "818-731-0360"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALLACE",
"first_name": "CATHERINE",
"middle_name": "JESSICA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-08-14",
"last_updated": "2024-08-13",
"certification_date": "2024-08-13",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "34791",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Sherman Oaks, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.