Kathleen M. Wallace, PSY.D

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PS015630 Issued in PA

Practice address

3400 Warren-Sharon Road
Vienna,, OH 44473-9532

Phone

(330) 720-5786

NPI assigned

Jan 19, 2007

Last updated

Sep 15, 2025By 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

Enrolled in PA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 1992

Medicare assignment

May accept Medicare assignment

Group practices

People in Need-Lawrence CountyGroup PAC ID 6305833963, 2 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

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.

• People in Need-Lawrence County

  • Community/Behavioral Health Agency
  • New Castle, PA
  • NPI 1558341867
  Medicare reassignment Care Compare group NPD
• Steward Medical Group Inc.

  • Internal Medicine Physician
  • Brookfield, OH
  • NPI 1902347438

  PA

  Medicare reassignment NPD
• People in Need - Lawrence County

  • Psychologist
  • New Castle, PA
  • NPI 1912077785

  Clinical

  NPD
• People in Need - Lawrence County

  • Counselor
  • New Castle, PA
  • NPI 1932424082
  NPD
• Steward Medical Group Inc.

  • Family Medicine Physician
  • Easton, PA
  • NPI 1073054458
  NPD
• Steward Medical Group, Inc

  • Specialist
  • Brighton, MA
  • NPI 1356654495
  NPD

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

{
    "created_epoch": "1169164800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1757894400000",
    "number": "1770636367",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3438 WARREN SHARON RD",
            "city": "VIENNA",
            "state": "OH",
            "postal_code": "444739532",
            "telephone_number": "330-720-5786"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3400 WARREN-SHARON ROAD",
            "city": "VIENNA,",
            "state": "OH",
            "postal_code": "444739532",
            "telephone_number": "330-720-5786"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2703 W State St",
            "address_purpose": "LOCATION",
            "city": "New Castle",
            "state": "PA",
            "postal_code": "161018645",
            "country_code": "US",
            "telephone_number": "724-657-3303 x101",
            "fax_number": "724-657-3326",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "KATHLEEN",
        "middle_name": "M.",
        "name_prefix": "Dr.",
        "credential": "PSY.D",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-01-19",
        "last_updated": "2025-09-15",
        "certification_date": "2025-09-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "PA",
            "license": "PS015630",
            "primary": true
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "OH",
            "license": "4820",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Vienna Dental Center, Bart L. James, DDS, Roger L. Clouse, DDS, LTD. (Vienna Dental Center)
• Vienna Medical Arts Clinic, Inc (Mark E. Davis, D.O.)
• Vienna Pharmacy Care LLC (Vienna Pharmacy Care)
• Vienna Township Ttee
• Vanessa Vince - Deniro, MSED, LPCC, LSW
• Kenneth Ralph Wallace II, PSY.D.

• Clinical Psychologist in Vienna, OH
• Providers in Vienna, OH by specialty
• Clinical Psychologist in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.