Active NPI
Katherine Sue Wallace, MS
- Addiction (Substance Use Disorder) Counselor
- Gideon, MO
National Provider Identifier
1942583893
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- License
- 6385
- Practice address
- 408 S Gideon Ave
Gideon, MO 63848-9200 - Phone
- (573) 370-2129
- NPI assigned
- Sep 27, 2011
- Last updated
- Sep 27, 2011
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 6385 | MO | Primary |
Addresses
Primary practice location
408 S Gideon Ave
Gideon, MO 63848-9200
Mailing address
408 S Gideon Ave
Gideon, MO 63848-9200
Phone (573) 370-2129
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
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6385 | MO | MD | Addiction (Substance Use Disorder) Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1317081600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1317081600000",
"number": "1942583893",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "408 S GIDEON AVE",
"city": "GIDEON",
"state": "MO",
"postal_code": "638489200",
"telephone_number": "573-370-2129"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "408 S GIDEON AVE",
"city": "GIDEON",
"state": "MO",
"postal_code": "638489200",
"telephone_number": "573-370-2129"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALLACE",
"first_name": "KATHERINE",
"middle_name": "SUE",
"name_prefix": "Ms.",
"credential": "MS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-09-27",
"last_updated": "2011-09-27",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "MO",
"license": "6385",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Gideon, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.