Carolyn Theresa Marie Wallace

Primary specialty

Case Manager/Care CoordinatorTaxonomy code 171M00000X

Practice address

1007 N 2ND St
Ironton, OH 45638-1235

Phone

(740) 442-7045

Fax

(740) 442-7047

NPI assigned

Oct 28, 2025

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1761609600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1761609600000",
    "number": "1083582365",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 614",
            "city": "IRONTON",
            "state": "OH",
            "postal_code": "456380614",
            "telephone_number": "740-442-7045",
            "fax_number": "740-442-7047"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1007 N 2ND ST",
            "city": "IRONTON",
            "state": "OH",
            "postal_code": "456381235",
            "telephone_number": "740-442-7045",
            "fax_number": "740-442-7047"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "CAROLYN",
        "middle_name": "THERESA MARIE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2025-10-28",
        "last_updated": "2025-10-28",
        "certification_date": "2025-10-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "cwallace@tpcwellness.org",
            "affiliation": "N",
            "endpointDescription": "email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1007 N 2nd St",
            "city": "Ironton",
            "state": "OH",
            "country_code": "US",
            "postal_code": "456381235",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Donna Wagner
• Jessecca Louise Walcott
• Walgreen Co
• Chelsea Walker
• Justin Mansfield Walker, CDCA
• Terri Lynn Wallace, CDCA,QMHS
• Justin Walters, PRS
• Ryan Andrew Warren
• Donald Washburn
• Cynthia Dawn Watson, APRN

• All providers in Ironton, OH
• Case Manager/Care Coordinator in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2025; 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.