Wallace, Rachel Ann
Wallace, Rachel Ann is an individual health care provider with primary practice located at 210 Pacific Ave N , Kelso WA 98626-3414. She recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Counselor, Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder). Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) is her primary health care specialty. Wallace, Rachel Ann can be contacted via phone (360) 423-0203.Contact Information
Primary practice address
210 Pacific Ave N
Kelso WA 98626-3414
Phone: (360) 423-0203
Fax: (360) 577-0269
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Counselor | 101Y00000X | 60336482 | Washington |
| Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) | 101YA0400X |
Profile Details
| NPI number | 1568989788 |
|---|---|
| LBN Legal business name | Wallace, Rachel Ann |
| Credentials | BA, CDPT |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Aug 28th, 2017 |
| Last updated | Nov 22nd, 2019 - about 7 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1568989788 | NPPES |
| Washington | MEDICAID | 2101606 |
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