Alexander Jeremy Wallace, MSW

Primary specialty

Social WorkerTaxonomy code 104100000X

License

ASW136556 Issued in CA

Practice address

1708 Banyan CT
Ceres, CA 95307-1907

Phone

(209) 531-2088

NPI assigned

Feb 13, 2026

Sex

Male

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

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.

• Elite Family Systems

  • Emotionally Disturbed Childrens' Residential Treatment Facility
  • Ceres, CA
  • NPI 1346820818
  NPD (past)
• Elite Family Systems

  • Emotionally Disturbed Childrens' Residential Treatment Facility
  • Ceres, CA
  • NPI 1679153142
  NPD (past)

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

{
    "created_epoch": "1770940800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1770940800000",
    "number": "1457203176",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "701 N TUXEDO AVE",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952045129"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1708 BANYAN CT",
            "city": "CERES",
            "state": "CA",
            "postal_code": "953071907",
            "telephone_number": "209-531-2088"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "ALEXANDER",
        "middle_name": "JEREMY",
        "credential": "MSW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2026-02-13",
        "last_updated": "2026-02-13",
        "certification_date": "2026-02-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "CA",
            "license": "ASW136556",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Maya Villalpando
• Lucero Villicana-Tellez
• Debra Vincent, BHS LL
• Vista del Sol Postacute Care (Ceres Postacute Care)
• Kiandra Nicole Walker
• Walmart Inc. (Walmart Pharmacy 10-1983)
• Walmart Stores, Inc. (Vision Center 30-1983)
• Jennifer Marie Leavens Washburn, NP
• Stacey Weaver
• Veronica Webster

• Social Worker in Ceres, CA
• Providers in Ceres, CA by specialty
• Social Worker in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 2026; 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.