Cindy Lee Wallace, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

10140193-3501 Issued in UT

Practice address

1206 W South Jordan Pkwy Ste D
South Jordan, UT 84095-5519

Phone

(801) 302-3801

Fax

(801) 302-7248

NPI assigned

Sep 7, 2015

Last updated

Jun 18, 2020By the provider in NPPES

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

Other names 1

• Cindy Lee Fowler Former name

Medicare fee-for-service enrollment

Enrolled in UT

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 1

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• South Point Counseling Services, LLC

  • Clinical Social Worker
  • South Jordan, UT
  • NPI 1265709844
  Medicare reassignment NPD
• Aspen Valley Counseling PC

  • Community/Behavioral Health Agency
  • Orem, UT
  • NPI 1326406596
  NPD (past)

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

{
    "created_epoch": "1441584000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1592438400000",
    "number": "1114395274",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1206 W SOUTH JORDAN PKWY STE D",
            "city": "SOUTH JORDAN",
            "state": "UT",
            "postal_code": "840955519",
            "telephone_number": "801-302-3801",
            "fax_number": "801-302-7248"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1206 W SOUTH JORDAN PKWY STE D",
            "city": "SOUTH JORDAN",
            "state": "UT",
            "postal_code": "840955519",
            "telephone_number": "801-302-3801",
            "fax_number": "801-302-7248"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "CINDY",
        "middle_name": "LEE",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-09-07",
        "last_updated": "2020-06-18",
        "certification_date": "2020-06-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "UT",
            "license": "10140193-3501",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CINDY",
            "last_name": "FOWLER",
            "middle_name": "LEE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Wal-Mart Stores, Inc (Walmart Vision Center 30-5763)
• Monica Walburn, DPT
• Walgreen Co (Walgreens #06669)
• Stacy Walker, MSN, APRN, FNP-C
• Benjamin Earl Wall, D.D.S.
• Jayden Denise Wallace
• Walmart Inc.
• Walmart Inc. (WalMart Pharmacy 10-5763)
• Paige Elyse Walston
• Walters Speech Therapy, LLC.

• Clinical Social Worker in South Jordan, UT
• Providers in South Jordan, UT by specialty
• Clinical Social Worker in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2020; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.