Active NPI
Daniel Wallace, DSW
- Social Worker
- Richton Park, IL
National Provider Identifier
1841771292
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- 150.106556
- Practice address
- 22997 Kristine LN
Richton Park, IL 60471-1273 - Phone
- (708) 925-7022
- NPI assigned
- Aug 23, 2018
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | 150.106556 | IL | Primary |
Addresses
Primary practice location
22997 Kristine LN
Richton Park, IL 60471-1273
Mailing address
22997 Kristine LN
Richton Park, IL 60471-1273
Phone (708) 925-7022
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| W42016193278 | Medicaid | IL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 150.106556 | IL | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1534982400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1706572800000",
"number": "1841771292",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "22997 KRISTINE LN",
"city": "RICHTON PARK",
"state": "IL",
"postal_code": "604711273",
"telephone_number": "708-925-7022"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "22997 KRISTINE LN",
"city": "RICHTON PARK",
"state": "IL",
"postal_code": "604711273",
"telephone_number": "708-925-7022"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALLACE",
"first_name": "DANIEL",
"name_prefix": "Dr.",
"credential": "DSW",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2018-08-23",
"last_updated": "2024-01-30",
"certification_date": "2024-01-30",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "IL",
"license": "150.106556",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "W42016193278",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Richton Park, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 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.