Rebecca Ann Wallace, MSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

60516 Issued in TX

Practice address

4950 Memorial Dr
Houston, TX 77007-7440

Phone

(713) 802-7714

Fax

(713) 802-6230

NPI assigned

Aug 31, 2010

Last updated

Jun 25, 2015By 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 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Apr 1, 2024 through Apr 1, 2028

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1283212800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1435190400000",
    "number": "1215243043",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4950 MEMORIAL DR",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770077440",
            "telephone_number": "713-802-7714"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4950 MEMORIAL DR",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770077440",
            "telephone_number": "713-802-7714",
            "fax_number": "713-802-6230"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "REBECCA",
        "middle_name": "ANN",
        "name_prefix": "Mrs.",
        "credential": "MSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-08-31",
        "last_updated": "2015-06-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "TX",
            "license": "60516",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Maria Annette Wallace
• Maureen Kay Wallace, RNFA
• Nyesha Wallace
• Pamela Lindsey Wallace, PT, DPT
• Phyllis Marie Wallace, CRNA
• Rebekah Wallace, LCSW
• Renata Wallace
• Shannon E Wallace
• Sharon Renee Wallace, MD
• Shawnee Wallace, DO

• Clinical Social Worker in Houston, TX
• Providers in Houston, TX by specialty
• Clinical Social Worker in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.