Courtney Nicole Wallace, AUD, CCC-A, F/AAA

Primary specialty

AudiologistTaxonomy code 231H00000X

Practice address

2530 Chicago Ave Ste 450
Minneapolis, MN 55404-4127

Phone

(612) 813-7610

NPI assigned

Jun 19, 2017

Sex

Female

Sole proprietor

No

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

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

{
    "created_epoch": "1497830400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1508396789",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "202 7TH ST W APT 515",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551023094",
            "telephone_number": "630-303-3209"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2530 CHICAGO AVE STE 450",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554044127",
            "telephone_number": "612-813-7610"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "COURTNEY",
        "middle_name": "NICOLE",
        "name_prefix": "Dr.",
        "credential": "AUD, CCC-A, F/AAA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-06-19",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "231H00000X",
            "taxonomy_group": "",
            "desc": "Audiologist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kyle Russell Wall, RN
• Michael H Wall, MD
• Stephanie Grace Wall
• Alaina M Wallace, LICSW
• Cecilia Wallace, MD
• Donna D Wallace, A.N.P.
• Hannah Wallace
• James Wallace, M.D.
• Meghan Wallace, OT
• Peter Allan Wallace

• Audiologist in Minneapolis, MN
• Providers in Minneapolis, MN by specialty
• Audiologist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.