Alaina M Wallace, LICSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

29798 Issued in MN

Practice address

3340 Republic Ave Ste 110
Minneapolis, MN 55426-4156

Phone

(952) 529-4474

Fax

(952) 209-1511

NPI assigned

Aug 30, 2024

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

Opted out of Medicare

Yes, effective Sep 24, 2024 through Sep 24, 2026

Medicare enrollment (NPD)

Not 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 and National Provider Directory roles.

• Novo Behavioral Health, LLC

  dba Natasha Parekh Phd LP

  • Professional Counselor
  • St Louis Park, MN
  • NPI 1629563929
  NPD

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

{
    "created_epoch": "1724976000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724976000000",
    "number": "1871327858",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3340 REPUBLIC AVE STE 110",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554264156",
            "telephone_number": "952-529-4474",
            "fax_number": "952-209-1511"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3340 REPUBLIC AVE STE 110",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554264156",
            "telephone_number": "952-529-4474",
            "fax_number": "952-209-1511"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "ALAINA",
        "middle_name": "M",
        "credential": "LICSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-08-30",
        "last_updated": "2024-08-30",
        "certification_date": "2024-08-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MN",
            "license": "29798",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brianna Wall, OTR/L
• Katherine Rachel Wall, RN
• Kyle Russell Wall, RN
• Michael H Wall, MD
• Stephanie Grace Wall
• Cecilia Wallace, MD
• Courtney Nicole Wallace, AUD, CCC-A, F/AAA
• Donna D Wallace, A.N.P.
• Hannah Wallace
• James Wallace, M.D.

• Clinical Social Worker in Minneapolis, MN
• Providers in Minneapolis, MN by specialty
• Clinical Social Worker in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 30, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.