Mary Wallace, is a
Psychologist - School based in Canton, Illinois. Mary Wallace is licensed to practice in * (Not Available) (license number ) and her current practice location is
1605 E Ash St, Canton, Illinois. She can be reached at her office (for appointments etc.) via phone at
(309) 647-6951.
NPI number for Mary Wallace is 1528585031 and her current mailing address is 1605 E Ash St, Canton, Illinois. She
does not participate in medicare program and thus does not accept medicare assignments. Her NPI Number is 1528585031.
Healthcare Provider's Profile
Full Name | Mary Wallace |
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Gender | Female |
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Speciality | Psychologist - School |
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Location | 1605 E Ash St, Canton, Illinois |
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Accepts Medicare Assignments | Does not participate in Medicare Program. She may not accept medicare assignment. |
NPI Data:
- NPI Number: 1528585031
- Provider Enumeration Date: 08/25/2017
- Last Update Date: 07/21/2022
Medical Identifiers
Medical identifiers for Mary Wallace such as npi, medicare ID, medicare PIN, medicaid, etc.
Identifier | Type | State | Issuer |
1528585031 | NPI | - | NPPES |
Medical Taxonomies and Licenses
Taxonomy | Type | License (State) | Status |
103TS0200X | Psychologist - School | (* (Not Available)) | Primary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Mary Wallace is
NOT enrolled with medicare and thus cannot prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
Mailing Address | Practice Location Address |
Mary Wallace, 1605 E Ash St, Canton, IL 61520-1510 Ph: (309) 647-6951 | Mary Wallace, 1605 E Ash St, Canton, IL 61520-1510 Ph: (309) 647-6951 |
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