Jailyn Wallace

Primary specialty

Case Manager/Care CoordinatorTaxonomy code 171M00000X

Practice address

626 Madison Ave
Toledo, OH 43604-1123

Phone

(707) 391-1752

NPI assigned

Aug 23, 2024

Sex

Male

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)

Not enrolled

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

{
    "created_epoch": "1724371200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1725321600000",
    "number": "1780417824",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "626 MADISON AVE",
            "city": "TOLEDO",
            "state": "OH",
            "postal_code": "436041123",
            "telephone_number": "707-391-1752"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "626 MADISON AVE",
            "city": "TOLEDO",
            "state": "OH",
            "postal_code": "436041123",
            "telephone_number": "707-391-1752"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "JAILYN",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2024-08-23",
        "last_updated": "2024-09-03",
        "certification_date": "2024-09-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Laren Allison Wall
• Larra Wall
• Caleb Wallace
• Darrnell Wallace
• Heather L Wallace, CMS
• Krina Wallace
• Sierra Wallace
• Stacy Wallace
• Trevor Wallace, CDCA
• Jill Waller

• Case Manager/Care Coordinator in Toledo, OH
• Providers in Toledo, OH by specialty
• Case Manager/Care Coordinator in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 3, 2024; 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.