MRS. LINDA WALLACE (NPI# 1225124167) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1225124167 |
| Entity Type | Individual |
| Full Name | MRS. LINDA WALLACE |
| Credential | APN RN |
| Practice Address |
1835 Kinghighway Washington Park IL 62204 |
| Practice Telephone | 6184827922 |
| Practice Fax Number | 6184827881 |
| Mailing Telephone | 6184827922 |
| Mailing Fax Number | 6184827881 |
| Enumeration Date | 2006-10-05 |
| Last Update Date | 2018-09-12 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 174400000X | Specialist | 209003499 | IL | Other Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | LICENSE | 209003499 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326538745 | Linda Marie Wallace | Registered Nurse | 18650 Nw Cornell Rd Ste 215, Hillsboro, OR 97124-9212 | 2018-05-10 |
| 1588029847 | Linda Wallace | Social Worker | 4500 San Pablo Rd S, Jacksonville, FL 32224-1865 | 2015-12-30 |
| 1659795441 | Linda Wallace | Physical Therapy Assistant | 5601 Hatchery Rd, Waterford, MI 48329-3451 | 2014-02-13 |
| 1184802787 | Linda W Wallace | Physical Therapist | 11740 Columbia St, Blakely, GA 39823-2574 | 2008-02-06 |
| 1184694473 | Linda M. Wallace | Audiologist | 1611 Cambridge St, Cambridge, MA 02138-4302 | 2006-01-26 |
| Street Address |
1835 KINGHIGHWAY |
| City | WASHINGTON PARK |
| State | IL |
| Zip Code | 62204 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205813714 | Syed K Hussain | Internal Medicine | 1835 Kingshighway, Washington Park, IL 62204 | 2005-12-27 |
| 1417477415 | Amanda Elizabeth Lappe | Occupational Therapist | 10000 W. 75th St., Ste. 250, Merrium, KS 62204 | 2017-06-21 |
| 1639402738 | Jeffery Scott Davis | Nurse Practitioner | 1835 Kingshighway, Washington Park, IL 62204 | 2009-09-08 |
| 1740345156 | Southern Illinois Healthcare Foundation, Inc. | Family Medicine | 1736 Kingshighway, East Saint Louis, IL 62204 | 2006-12-26 |
| 1588778831 | Scott Christopher Schultz | Dentist | 1835 Kingshighway, Washington Park, IL 62204 | 2006-08-17 |
| 1326309774 | Kischa Moton | Occupational Therapy Assistant | 3019 Lincoln Ave, East Saint Louis, IL 62204-1110 | 2012-06-01 |
| 1649212267 | Cramar Pharmacy Inc | Pharmacy | 6104 Forest Blvd, East Saint Louis, IL 62204-1660 | 2006-06-11 |
| 1700155595 | House of Prayer Christian Academy | Counselor | 5501 N Park Dr, East Saint Louis, IL 62204-2121 | 2011-12-22 |
| 1366711939 | Tina Yvonne Pettiford | Counselor | 5501 N Park Dr, East Saint Louis, IL 62204-2121 | 2011-12-27 |
| 1336258540 | Southern Illinois Regional Wellness Center | Clinic/Center | 1736 Kingshighway, East Saint Louis, IL 62204-2134 | 2006-08-30 |
| Find all providers in zip 62204 | ||||
| Taxonomy Code | 174400000X |
| Grouping | Other Service Providers |
| Classification | Specialist |
| An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |
| Notes: Source: Expanded from Webster’s II New Riverside University Dictionary, Boston: Riverside Publishing Company, 1974. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447850730 | Nirvana Medspa and Laser Center, Ltd | Specialist | 11801 Southwest Hwy Ste 2n, Palos Heights, IL 60463-1069 | 2020-10-27 |
| 1801402938 | Terri Sendelbach | Specialist | 340 W Butterfield Rd Ste 4b-418, Elmhurst, IL 60126-5069 | 2020-09-23 |
| 1346899630 | Jeremy Gantz Morse | Specialist | 815 W Buena Ave, Chicago, IL 60613-1694 | 2019-09-09 |
| 1619539632 | Benjamin Mendoza | Specialist | 6303 W 63rd St Unit 3c, Chicago, IL 60638-7015 | 2019-06-29 |
| 1891356176 | Kristin Michelle Stahlheber | Specialist | 6718 Goshen Rd, Edwardsville, IL 62025-3025 | 2019-06-26 |
| 1689238438 | Sara Sladoje | Specialist | 936 Raleigh Rd, Glenview, IL 60025-4330 | 2019-04-26 |
| 1760940100 | Eqmd, Inc. | Specialist | 1800 Nations Dr Ste 216, Gurnee, IL 60031-9174 | 2019-03-05 |
| 1962979286 | Time 2 Talk, LLC | Specialist | 6791 Wesley Chapel Rd, Chatham, IL 62629-9722 | 2018-10-24 |
| 1871068783 | Kelsey Lynn Mora | Specialist | 5225 Old Orchard Rd Ste 14, Skokie, IL 60077-1027 | 2018-10-06 |
| 1811471808 | Judith M Penn | Specialist | 8312 S Kedzie Ave, Chicago, IL 60652-3309 | 2018-09-17 |
| Find all providers with the same taxonomy | ||||
| City | WASHINGTON PARK |
| Zip Code | 62204 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.