Heidi Allison Wilken Wallace, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

149012947 Issued in IL

Practice address

27566 1375 East St
Walnut, IL 61376-9528

Phone

(815) 383-7277

Fax

(815) 379-2184

NPI assigned

Feb 6, 2007

Last updated

Nov 19, 2012By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Heidi Allison Wilken Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1170720000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1353283200000",
    "number": "1528107471",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "27566 1375 EAST ST",
            "city": "WALNUT",
            "state": "IL",
            "postal_code": "613769528",
            "telephone_number": "815-383-7277",
            "fax_number": "815-379-2184"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "27566 1375 EAST ST",
            "city": "WALNUT",
            "state": "IL",
            "postal_code": "613769528",
            "telephone_number": "815-383-7277",
            "fax_number": "815-379-2184"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "HEIDI",
        "middle_name": "ALLISON WILKEN",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-02-06",
        "last_updated": "2012-11-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149012947",
            "primary": true
        },
        {
            "code": "222Q00000X",
            "taxonomy_group": "",
            "desc": "Developmental Therapist",
            "state": "IL",
            "license": "HW49060306P",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EARLY INTERVENTION",
            "identifier": "HW49060306P",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "HEIDI",
            "last_name": "WILKEN",
            "middle_name": "ALLISON",
            "credential": "LCSW",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Kelly Cotaleen Todd, PNP
• Walnut Fire Department Inc
• Walnut Fire Protection District

• Clinical Social Worker in Walnut, IL
• Providers in Walnut, IL by specialty
• Clinical Social Worker in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2012; 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.