Wallace, Erin Melissa

Wallace, Erin Melissa is an individual health care provider with primary practice located at 16338 N Il Highway 37 , Mount Vernon IL 62864-8178. She recently has only one registered license in Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder), which is considered as her primary health care specialty. Wallace, Erin Melissa can be contacted via phone (618) 242-5835.

Contact Information

Primary practice address
16338 N Il Highway 37 Mount Vernon IL 62864-8178
Phone: (618) 242-5835
Fax: (618) 242-6392
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) 101YA0400X Illinois

Profile Details

NPI number 1477063444
LBN Legal business name Wallace, Erin Melissa
Credentials BS/CADC
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 4th, 2017
Last updated Oct 4th, 2017 - about 9 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1477063444 NPPES
Illinois MEDICAID 1649404708

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