Caron Elizabeth Wallace, CDPT

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

60696850 Issued in WA

Practice address

825 E 5TH St
Port Angeles, WA 98362-3818

Phone

(360) 477-4790

Fax

(360) 477-4802

NPI assigned

Nov 8, 2018

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

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

{
    "created_epoch": "1541635200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1541635200000",
    "number": "1770051674",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "825 E 5TH ST",
            "city": "PORT ANGELES",
            "state": "WA",
            "postal_code": "983623818",
            "telephone_number": "360-477-4790",
            "fax_number": "360-477-4802"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "825 E 5TH ST",
            "city": "PORT ANGELES",
            "state": "WA",
            "postal_code": "983623818",
            "telephone_number": "360-477-4790",
            "fax_number": "360-477-4802"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "CARON",
        "middle_name": "ELIZABETH",
        "credential": "CDPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-11-08",
        "last_updated": "2018-11-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "WA",
            "license": "60696850",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Wal-Mart Stores, Inc
• Walgreen Co
• Danyelle J Walker, DDS
• Justin Ford Walker
• Michael Walker
• Mary Terese Wallace
• Emily Marie Wallen, DO
• Dianna L Waller, P.T.
• Steven E Walls, FNP
• Walmart Inc.

• Addiction (Substance Use Disorder) Counselor in Port Angeles, WA
• Providers in Port Angeles, 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 8, 2018; 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.