Kati Wallace

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

34010387A Issued in IN

Practice address

3 W Boone St
Cloverdale, IN 46120-9003

Phone

(812) 605-9748

NPI assigned

Jun 11, 2024

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

Medicare fee-for-service enrollment

Enrolled in IN

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

Specialty

Clinical Social Worker

Education

Other, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Putnam County HospitalGroup PAC ID 1951396605, 46 clinicians

Practice addresses (Care Compare)

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 and National Provider Directory roles.

• Putnam County Hospital

  • Critical Access Hospital
  • Greencastle, IN
  • NPI 1578608188
  Medicare reassignment Care Compare group NPD
• Putnam County Hospital

  • Rural Health Clinic/Center
  • Greencastle, IN
  • NPI 1295972412
  NPD
• Putnam County Hospital

  • Rural Health Clinic/Center
  • Cloverdale, IN
  • NPI 1578621389
  NPD

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

{
    "created_epoch": "1718064000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1759449600000",
    "number": "1245072073",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3 W BOONE ST",
            "city": "CLOVERDALE",
            "state": "IN",
            "postal_code": "461209003",
            "telephone_number": "812-605-9748"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3 W BOONE ST",
            "city": "CLOVERDALE",
            "state": "IN",
            "postal_code": "461209003",
            "telephone_number": "812-605-9748"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1542 S Bloomington St",
            "address_purpose": "LOCATION",
            "city": "Greencastle",
            "state": "IN",
            "postal_code": "461352297",
            "country_code": "US",
            "telephone_number": "765-301-7300",
            "fax_number": "765-301-7491",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "KATI",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-06-11",
        "last_updated": "2025-10-03",
        "certification_date": "2025-10-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IN",
            "license": "34010387A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alexis Stout
• Kalen Elyse Sundeen, PA-C
• Michelle R Thomas
• Judy K Thrasher, PTA
• Teresa L Tomamichel, COTA
• Wesleyan Homes of Indiana, Inc.

• Clinical Social Worker in Cloverdale, IN
• Providers in Cloverdale, IN by specialty
• Clinical Social Worker in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 2025; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.