Anne M. Wallace, PH.D.

Primary specialty

Clinical Child & Adolescent PsychologistTaxonomy code 103TC2200X

License

5360 Issued in OH

Practice address

3327 Orion Ave
Cincinnati, OH 45213-1707

Phone

(513) 531-6116

Fax

(513) 531-4640

NPI assigned

Jan 28, 2008

Last updated

Jan 28, 2008By 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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

State licenses

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

{
    "created_epoch": "1201478400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1201478400000",
    "number": "1548447030",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3327 ORION AVE",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452131707",
            "telephone_number": "513-531-6116",
            "fax_number": "513-531-4640"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3327 ORION AVE",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452131707",
            "telephone_number": "513-531-6116",
            "fax_number": "513-531-4640"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "ANNE",
        "middle_name": "M.",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-01-28",
        "last_updated": "2008-01-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC2200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "OH",
            "license": "5360",
            "primary": true
        },
        {
            "code": "103TC2200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "KY",
            "license": "1240",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shelby Wall
• Wallace Family Dentistry LLC
• Wallace Physician Services LLC
• Alexandria Wallace
• Allison Wallace, MSW, MFT
• Brandon Tobias Wallace, DMD
• Chasei Wallace
• Chiquita Wallace
• Christina Wallace
• Christine Wallace, MD

• Clinical Child & Adolescent Psychologist in Cincinnati, OH
• Providers in Cincinnati, OH by specialty
• Clinical Child & Adolescent Psychologist in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2008; 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.