Karen L Wallace, RD, CD

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

DI00000485 Issued in WA

Practice address

15418 Main St
Ste 301
Mill Creek, WA 98012-9030

Phone

(425) 385-3262

Fax

(425) 357-0924

NPI assigned

Jan 10, 2007

Sex

Female

Sole proprietor

Yes

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)

Enrolled

State licenses

Practice roles

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.

• Jennifer Gross, PSYD, Inc

  • Clinic/Center
  • Mill Creek, WA
  • NPI 1386398816
  NPD (past)
• Summit Consulting Group, Inc.

  • Clinical Psychologist
  • Mill Creek, WA
  • NPI 1568525251
  NPD (past)

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

{
    "created_epoch": "1168387200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1760532113",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15418 MAIN STREET",
            "address_2": "SUITE 301",
            "city": "MILL CREEK",
            "state": "WA",
            "postal_code": "98012",
            "telephone_number": "425-385-3262",
            "fax_number": "425-357-0924"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15418 MAIN ST",
            "address_2": "STE 301",
            "city": "MILL CREEK",
            "state": "WA",
            "postal_code": "980129030",
            "telephone_number": "425-385-3262",
            "fax_number": "425-357-0924"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "KAREN",
        "middle_name": "L",
        "name_prefix": "Ms.",
        "credential": "RD, CD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-01-10",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "WA",
            "license": "DI00000485",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Elenora P Von, MSW, LICSW
• Shobhna Wadhwa, MS
• Michael Scott Wagner, OD
• Matthew Wah, PT
• Dariusz Walczak, MD
• Nicole Michelle Walsh, LMP
• Kim A Walter, DDS
• Jennifer J Walters, ND
• Christina Wang, O.D.
• Jason Wang

• Registered Dietitian in Mill Creek, WA
• Providers in Mill Creek, WA by specialty
• Registered Dietitian in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.