Julia Lynette Wallace, TEMPORARY CSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

258426 Issued in KY

Practice address

1175 Cane Valley Rd
Columbia, KY 42728-9540

Phone

(270) 384-6750

NPI assigned

Sep 25, 2023

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

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Spectrum Care Academy Bluegrass II

  dba Skopos Care

  • Psychiatric Residential Treatment Facility
  • Columbia, KY
  • NPI 1598234114
  NPD

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

{
    "created_epoch": "1695600000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1695600000000",
    "number": "1730968363",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25640 LOUISVILLE RD",
            "city": "PARK CITY",
            "state": "KY",
            "postal_code": "421607729",
            "telephone_number": "270-250-4733"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1175 CANE VALLEY RD",
            "city": "COLUMBIA",
            "state": "KY",
            "postal_code": "427289540",
            "telephone_number": "270-384-6750"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "JULIA",
        "middle_name": "LYNETTE",
        "credential": "TEMPORARY CSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-09-25",
        "last_updated": "2023-09-25",
        "certification_date": "2023-09-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "KY",
            "license": "258426",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Donna S Vincent, APRN
• Vocals2Go
• Wal-Mart Stores East LP (Walmart Pharmacy 10-0569)
• Wal-Mart Stores, Inc. (Vision Center 30-0569)
• Dakota James Wallace
• Steven R Warren
• Kandace Diane Webster, APRN
• Westlake Home Health
• Westlake Nurse Anesthesia Group
• Westlake Regional Hospital Medical Group

• Clinical Social Worker in Columbia, KY
• Providers in Columbia, KY by specialty
• Clinical Social Worker in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2023; 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.