Kaley C Wallace, M.S., CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

6562 Issued in TN

Practice address

1601 Sailmaker Way # B109
Knoxville, TN 37920-5467

Phone

(423) 335-1398

NPI assigned

Sep 10, 2019

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

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

State licenses

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

{
    "created_epoch": "1568073600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1592265600000",
    "number": "1306495452",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1601 SAILMAKER WAY # B109",
            "city": "KNOXVILLE",
            "state": "TN",
            "postal_code": "379205467"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1601 SAILMAKER WAY # B109",
            "city": "KNOXVILLE",
            "state": "TN",
            "postal_code": "379205467",
            "telephone_number": "423-335-1398"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "KALEY",
        "middle_name": "C",
        "credential": "M.S., CCC-SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-09-10",
        "last_updated": "2020-06-16",
        "certification_date": "2020-06-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "TN",
            "license": "0000006562",
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "TN",
            "license": "6562",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SPEECH LANGUAGE PATHOLOGIST",
            "identifier": "0000006562",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Heather Ann Wallace
• James Ryan Wallace, CRNA
• Jeffery Wallace
• Jessica Wallace, MA, NCC
• Judy C Wallace
• Kelsey Spiller Wallace
• Trevor A Wallace, PT
• Samantha Wallenstein, AU.D.,CCC-A
• Kerri Waller, M.S.
• Thomas Jordan Walley

• Speech-Language Pathologist in Knoxville, TN
• Providers in Knoxville, TN by specialty
• Speech-Language Pathologist in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2020; 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.