Rachel Ann Wallace, BA, CDPT

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

Practice address

210 Pacific Ave N
Kelso, WA 98626-3414

Phone

(360) 423-0203

Fax

(360) 577-0269

NPI assigned

Aug 28, 2017

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)

Not enrolled

Credentials

Bachelor of Arts

State licenses

Practice roles

Locations

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.

• Columbia Wellness

  • Case Management Agency
  • Longview, WA
  • NPI 1487659579
  NPD

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

{
    "created_epoch": "1503878400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1574380800000",
    "number": "1568989788",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1847",
            "city": "LONGVIEW",
            "state": "WA",
            "postal_code": "986328140",
            "telephone_number": "360-423-0203",
            "fax_number": "360-557-0269"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "210 PACIFIC AVE N",
            "city": "KELSO",
            "state": "WA",
            "postal_code": "986263414",
            "telephone_number": "360-423-0203",
            "fax_number": "360-577-0269"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "RACHEL",
        "middle_name": "ANN",
        "credential": "BA, CDPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-08-28",
        "last_updated": "2019-11-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "WA",
            "license": "60336482",
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2101606",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jessica Lucile Tracy, LPN
• Taylor Trevino, RPH
• Tatiana Trott, DDS
• Shane Aaron Van Fossen, CO70013818
• Jaime Vandervoort, MSW, LSWAIC
• Joey Adam Wardell
• Washington CVS Pharmacy LLC
• WCHS Inc
• Marguerite Nonnie Weaver, LCSW
• Gregory A Webster, OD

• Addiction (Substance Use Disorder) Counselor in Kelso, WA
• Providers in Kelso, WA by specialty
• Addiction (Substance Use Disorder) Counselor in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 22, 2019; 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.