AMANDA MARIE WALLACE


Address: 205 Main St E, Mohall, ND 58761-4014
Phone: 7017566374

AMANDA MARIE WALLACE (NPI# 1952808024) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1952808024
Entity Type Individual
Full Name AMANDA MARIE WALLACE
Credential LCSW
Practice Address 205 Main St E
Mohall
ND 58761-4014
Mailing Address Po Box 305
Mohall
ND 58761-0305
Practice Telephone 7017566374
Mailing Telephone 7017566374
Enumeration Date 2018-04-06
Last Update Date 2018-04-06
Gender Code F
Is Sole Proprietor N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 171M00000X Case Manager/Care Coordinator 4524 ND Other Service Providers

Other Provider Identifier

State Issuer Identifier Type Code
ND 1473894 05

Other Providers AMANDA WALLACE

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1972015659 Amanda Wallace Behavior Technician 41521 W 11 Mile Rd, Novi, MI 48375-1803 2017-11-02
1154844041 Amanda Gail Wallace Nurse Practitioner 142 Depot Dr, South Shore, KY 41175-9306 2017-07-21
1578097341 Amanda Wallace Physical Therapist 2115 Dulles Dr, Lafayette, LA 70506-2652 2017-04-18
1649665977 Amanda Rose Wallace Psychiatry & Neurology 525 E 68th St, New York, NY 10065 2015-04-03
1972908010 Amanda Jo Wallace Psychologist 1500 N Westwood Blvd, Poplar Bluff, MO 63901-3318 2014-10-31
1578964888 Amanda Leigh Wallace Speech-Language Pathologist 928 W Market St, Tiffin, OH 44883-2529 2014-09-07
1053725952 Amanda Wallace Speech-Language Pathologist 40w310 Lafox Rd, Suite A1/b1, St Charles, IL 60175-6588 2014-06-18

Office Location

Street Address 205 MAIN ST E
City MOHALL
State ND
Zip Code 58761-4014

Providers in the same location

NPI Name Taxonomy Address Enumeration
1295243277 Renville County Social Services Case Management 205 Main St E, Mohall, ND 58761-4014 2018-01-12

Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1003148644 Melanie Ray Skar Physical Medicine & Rehabilitation 602 Main St. E, Good Samaritan Center, Mohall, ND 58761 2010-02-08
1154411676 Mohall Ambulance Service Ambulance 105 Main St West, Mohall, ND 58761 2006-10-13
1114013604 Theodore A Brown Dentist 106 3rd Ave Se, Mohall, ND 58761 2006-10-04
1033273339 Paul Daniel Herigstad Chiropractor 202 5th St Nw, Mohall, ND 58761-0721 2006-12-20
1235730136 Cindy Mae Anderson Technician 207 Central Ave S, Mohall, ND 58761-4066 2020-11-05
1861473852 The Evangelical Lutheran Good Samaritan Society Durable Medical Equipment & Medical Supplies 602 Main St E, Mohall, ND 58761-4100 2005-11-08
1457717746 Kayla Fisher Speech-Language Pathologist 602 Main St E, Mohall, ND 58761-4100 2016-01-04
1497138796 Jan L Weathers Community Health Worker 602 Main St E, Mohall, ND 58761-4100 2015-07-04
1578761649 Krista Hope Becker Physical Therapist 602 Main St E, Mohall, ND 58761-4100 2007-07-10
1184013047 Virginia Jean Faulkner Chiropractor 101 Central Ave S, Ste 3, Mohall, ND 58761-4214 2015-01-15
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Taxonomy Information

Taxonomy Code 171M00000X
Grouping Other Service Providers
Classification Case Manager/Care Coordinator

Taxonomy Definition

A person who provides case management services and assists an individual in gaining access to needed medical, social, educational, and/or other services. The person has the ability to provide an assessment and review of completed plan of care on a periodic basis. This person is also able to take collaborative action to coordinate the services with other providers and monitor the enrollee’s progress toward the cost-effective achievement of objectives specified in the plan of care. Credentials may vary from an experience in the fields of psychology, social work, rehabilitation, nursing or a closely related human service field, to a related Assoc of Arts Degree or to nursing credentials. Some states may require certification in case management.
Notes: Source: CMS State Medicaid Manual Section 4442.3 [7/1/2006: new]

Providers in the same taxonomy and state

NPI Name Taxonomy Address Enumeration
1891300794 Heather Leier Case Manager/Care Coordinator 101 16th St Sw, Minot, ND 58701-3463 2020-09-09
1659913879 Christine Lawson Case Manager/Care Coordinator 531 W Villard St, Dickinson, ND 58601-5044 2019-10-09
1912549130 Emily Gran Case Manager/Care Coordinator 531 W Villard St Ste 1, Dickinson, ND 58601-5044 2019-10-09
1821639899 Brooke Peacock Case Manager/Care Coordinator 1008 4th Ave, Apt 116, Watford City, ND 58854-5885 2019-10-01
1104467174 Fallon Kirby Maston Case Manager/Care Coordinator 1008 4th Ave Se Apt 116, Watford City, ND 58854-7732 2019-10-01
1942854260 Johnita Whyte Case Manager/Care Coordinator 225 3rd St Se Fl 3, Minot, ND 58701-3958 2019-07-25
1225597750 Missi Baranko Case Manager/Care Coordinator 4758 92nd Ave Sw, Richardton, ND 58652-9710 2019-03-14
1194216481 Richard Yonick Case Manager/Care Coordinator South Central Human Service Center, 520 3rd St Nw, Jamestown, ND 58401 2018-05-23
1972092757 William David Nix Case Manager/Care Coordinator 102 Main Ave W, Rolla, ND 58367 2018-05-07
1245748649 Alissa Lynn Parsons Case Manager/Care Coordinator Chase Building, 2nd Floor, 516 Cooper Avenue, Grafton, ND 58237 2018-01-19
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Competitor

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City MOHALL
Zip Code 58761

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Dataset Information

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.

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