Mary Wallace

Primary specialty

Case Manager/Care CoordinatorTaxonomy code 171M00000X

License

CG60538865 Issued in WA

Practice address

627 S Elliott Ave
Wenatchee, WA 98801-3195

Phone

(509) 888-5646

NPI assigned

May 27, 2016

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

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Catholic Family & Child Service

  • Mental Illness Community Based Residential Treatment Facility
  • Wenatchee, WA
  • NPI 1245687904
  NPD (past)

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

{
    "created_epoch": "1464307200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1512604800000",
    "number": "1194173443",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "627 S ELLIOTT AVE",
            "city": "WENATCHEE",
            "state": "WA",
            "postal_code": "988013195",
            "telephone_number": "509-888-5646"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "627 S ELLIOTT AVE",
            "city": "WENATCHEE",
            "state": "WA",
            "postal_code": "988013195",
            "telephone_number": "509-888-5646"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "MARY",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-05-27",
        "last_updated": "2017-12-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": "WA",
            "license": "CG60538865",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2091091",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Brett Walker, PT
• Morgan Walker, MS, LMHC-A
• David William Wall, DC
• Ethan Henry Wall, LPN
• Kathryn D Wallace, OT
• Hannah Ashlynn Wallen, DO
• Walmart
• Walmart Inc.
• Allie N. Walsh, PA-C
• Cameron Ray Walter, DPT

• Case Manager/Care Coordinator in Wenatchee, WA
• Providers in Wenatchee, WA by specialty
• Case Manager/Care Coordinator in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 7, 2017; 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.