MRS. ERIN MELISSA WALLACE BS/CADC NPI 1477063444

NPI Information

NPI: 1477063444
Provider Name: MRS. ERIN MELISSA WALLACE, BS/CADC
Classification: Counselor - 101YA0400X
Entity Type: Individual

Specialization: Addiction (Substance Use Disorder)

Address:
16338 N IL HIGHWAY 37
MOUNT VERNON, IL
ZIP 62864
Phone: (618) 242-5835
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MRS. Erin Melissa Wallace, BS/CADC is an addiction (substance use disorder) counselor in Mount Vernon, IL. MRS. Erin Melissa Wallace, BS/CADC NPI is 1477063444. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

16338 N IL HIGHWAY 37
MOUNT VERNON, IL
ZIP 62864-178
Phone: (618) 242-5835
Fax: (618) 242-6392

The enumeration date for this NPI number is 10/4/2017 and was last updated on 10/4/2017.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	101YA0400X	Counselor	Addiction (Substance Use Disorder)		ILLINOIS	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	1649404708	MEDICAID	ILLINOIS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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