DR. JO L WALLACE (NPI# 1811058431) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1811058431 |
| Entity Type | Individual |
| Full Name | DR. JO L WALLACE |
| Credential | PHD, LMFT, ATR-BC |
| Practice Address |
2166 Union St San Francisco CA 94123-4004 |
| Mailing Address |
3750 Scott St Apt 303 San Francisco CA 94123-1179 |
| Practice Telephone | 6506173800 |
| Practice Fax Number | 6506880206 |
| Mailing Telephone | 6504837831 |
| Enumeration Date | 2006-12-13 |
| Last Update Date | 2015-04-10 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 103G00000X | Clinical Neuropsychologist | 26254 | CA | Behavioral Health & Social Service Providers |
| N | 103T00000X | Psychologist | PSY26254 | CA | Behavioral Health & Social Service Providers |
| N | 106H00000X | Marriage & Family Therapist | 43134 | CA | Behavioral Health & Social Service Providers |
| Street Address |
2166 UNION ST |
| City | SAN FRANCISCO |
| State | CA |
| Zip Code | 94123-4004 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437611357 | Sarah Wenton Alexander | Occupational Therapist | 3007 Fillmore Street #3, San Francisco, CA 94123 | 2019-04-01 |
| 1306203138 | Cora Ann Keene | Marriage & Family Therapist | 1795 Union St, San Francisco, CA 94123 | 2016-01-25 |
| 1437556818 | Haley Alexander | Behavioral Analyst | 3750 Scott St Apt 205, San Francisco, CA 94123 | 2014-12-01 |
| 1992055040 | Robert J Buonfiglio | Psychologist | 1738 Union Street # 302, San Francisco, CA 94123 | 2012-09-17 |
| 1750656732 | Jane C Freston | Occupational Therapist | 1849 Chestnut Street, Apartment 4, San Francisco, CA 94123 | 2012-03-09 |
| 1700114212 | Marlene Ellen Kushner | Marriage & Family Therapist | 2918 Webster Street, San Francisco, CA 94123 | 2009-11-20 |
| 1487980447 | Acupuncture for Athletics | Acupuncturist | 1996 Union Street, 3rd Floor, San Francisco, CA 94123 | 2009-10-27 |
| 1104054436 | Sarah Elizabeth Bothe | Psychologist | 1738 Union Street, Suite 200, San Francisco, CA 94123 | 2009-06-25 |
| 1407099609 | Erika Cardamone | Speech-Language Pathologist | 2941 Gough St, 2, San Francisco, CA 94123 | 2009-04-17 |
| 1528216009 | Melissa Jeans Maglaque | Physical Therapist | 2065 Vallejo St Apt 3, San Francisco, CA 94123 | 2008-09-09 |
| Find all providers in zip 94123 | ||||
| Taxonomy Code | 103G00000X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Clinical Neuropsychologist |
| An individual with a doctorate degree, licensure in clinical psychology and specialized training or board certification in neuropsychology who practices or adheres to the principles of neuropsychology; a specialty within the field of psychology focusing primarily on neurobehavioral functioning. |
| Notes: Source: American Psychological Association, Washington, DC, 1997. [1/1/2007: title modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447800842 | Lainie Falco Posecion | Clinical Neuropsychologist | 1340 Taylor St Apt 6, San Francisco, CA 94108-1033 | 2019-09-17 |
| 1174909824 | Ronald H Roberts | Clinical Neuropsychologist | 2000 Van Ness Ave Ste 512, San Francisco, CA 94109-3017 | 2015-08-05 |
| 1912383886 | Gina Pfeifle | Clinical Neuropsychologist | 1825 Fourth Street, 6th Floor, M-6395, Ucsf Bx 4054, San Francisco, CA 94143 | 2015-08-03 |
| 1912293168 | Lisa Sporri | Clinical Neuropsychologist | 912 Cole St # 275, San Francisco, CA 94117-4316 | 2011-06-27 |
| 1376847293 | Ricardo Winkel | Clinical Neuropsychologist | 101 California St Ste 2450, San Francisco, CA 94111-6102 | 2011-01-06 |
| 1023318540 | Helen Chen | Clinical Neuropsychologist | 909 Hyde St Ste 620, San Francisco, CA 94109-4847 | 2010-11-01 |
| 1669789194 | Nicole Lara Sucre | Clinical Neuropsychologist | 1700 Pierce St Ste 103, San Francisco, CA 94115-3187 | 2010-09-03 |
| 1174842041 | Eric Michael Fine | Clinical Neuropsychologist | 533 Parnassus Ave, Uc Hall 426, Ucsf Memory and Aging Center, San Francisco, CA 94117 | 2010-05-18 |
| 1861632408 | Nataliya Belfor | Clinical Neuropsychologist | 2299 Post St Ste 307, San Francisco, CA 94115-3441 | 2009-02-23 |
| 1295971984 | Amanda Gregory | Clinical Neuropsychologist | 3644 Market St, San Francisco, CA 94131-1339 | 2008-12-30 |
| Find all providers in SAN FRANCISCO | ||||
| City | SAN FRANCISCO |
| Zip Code | 94123 |
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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.