Ian Wallace, MS, CGC

Primary specialty

Genetic Counselor (M.S.)Taxonomy code 170300000X

Practice address

1620 SE Summit CT
Pullman, WA 99163-5540

Phone

(509) 332-5106

Fax

(509) 334-5723

NPI assigned

Aug 2, 2010

Sex

Male

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

Eligible to order & refer

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

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

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

{
    "created_epoch": "1280707200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1317859200000",
    "number": "1942514930",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1620 SE SUMMIT CT",
            "city": "PULLMAN",
            "state": "WA",
            "postal_code": "991635540",
            "telephone_number": "509-332-5106",
            "fax_number": "509-334-5723"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1620 SE SUMMIT CT",
            "city": "PULLMAN",
            "state": "WA",
            "postal_code": "991635540",
            "telephone_number": "509-332-5106",
            "fax_number": "509-334-5723"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "IAN",
        "credential": "MS, CGC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-08-02",
        "last_updated": "2011-10-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "170300000X",
            "taxonomy_group": "",
            "desc": "Genetic Counselor, MS",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Wal-Mart Stores Inc
• Abigail Waldo, ATC
• Matthew Walker, OD
• Jennifer Wall, COTA
• Emily Brooke Wallace, PHARM.D. CANDIDATE
• Gregory Wallis, DO
• Walmart Inc.
• Cameron Walsworth
• Jeffrey Loren Ward, DO
• Sanford T. Ward, D.O.

• Genetic Counselor (M.S.) in Pullman, WA
• Providers in Pullman, WA by specialty
• Genetic Counselor (M.S.) in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 2011; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.