Mallory Wallace

Primary specialty

Intellectual and/or Developmental Disabilities Residential Treatment FacilityTaxonomy code 320600000X

Practice address

8725 Brooks Creek Dr Apt 2125
Cincinnati, OH 45249-2089

Phone

(424) 333-5672

NPI assigned

Mar 28, 2023

Sex

Female

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": "1679961600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1679961600000",
    "number": "1972207504",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8725 BROOKS CREEK DR APT 2125",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452492089"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8725 BROOKS CREEK DR APT 2125",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452492089",
            "telephone_number": "424-333-5672"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "MALLORY",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-03-28",
        "last_updated": "2023-03-28",
        "certification_date": "2023-03-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Geri Wallace
• Jennifer Lynn Wallace, LPN
• John E Wallace, DPT
• Laurie A. Wallace, APRN
• Mallory Wallace
• Marilyn Wallace
• Matthew Christopher Wallace, M.D.
• Mayon Joel Wallace
• Megan Wallace, CRNA
• Melissa A. Wallace, D.O.

• Intellectual and/or Developmental Disabilities Residential Treatment Facility in Cincinnati, OH
• Providers in Cincinnati, OH by specialty
• Intellectual and/or Developmental Disabilities Residential Treatment Facility in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2023; 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.