Dr Susan 'suzi' Wallace, PHD, PT, LPC is a
Psychologist - Clinical based in Fort Smith, Arkansas. Dr Susan 'suzi' Wallace is licensed to practice in Arkansas (license number 18-08P) and her current practice location is
5111 Rogers Avenue, Suite 533, Central Mall Plaza Suites #533, Fort Smith, Arkansas. She can be reached at her office (for appointments etc.) via phone at
(479) 651-7413.
NPI number for Dr Susan 'suzi' Wallace is 1124215256 and her current mailing address is 4711 Oak Hollow Lane, Fort Smith, Arkansas. She
does not participate in medicare program and thus does not accept medicare assignments. Her NPI Number is 1124215256.
Healthcare Provider's Profile
| Full Name | Dr Susan 'suzi' Wallace |
|---|
| Gender | Female |
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| Speciality | Psychologist - Clinical |
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| Location | 5111 Rogers Avenue, Suite 533, Fort Smith, Arkansas |
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| Accepts Medicare Assignments | Does not participate in Medicare Program. She may not accept medicare assignment. |
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NPI Data:
- NPI Number: 1124215256
- Provider Enumeration Date: 10/03/2007
- Last Update Date: 08/30/2018
Medical Identifiers
Medical identifiers for Dr Susan 'suzi' Wallace such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1124215256 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 101YP2500X | Counselor - Professional | A0510074 (Arkansas) | Secondary |
| 225100000X | Physical Therapist | 1724 (Arkansas) | Secondary |
| 103TC0700X | Psychologist - Clinical | 18-08P (Arkansas) | 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. Dr Susan 'suzi' 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 |
|---|
Dr Susan 'suzi' Wallace, PHD, PT, LPC
4711 Oak Hollow Lane,
Fort Smith, AR 72903
Ph: (479) 651-7413 | Dr Susan 'suzi' Wallace, PHD, PT, LPC
5111 Rogers Avenue, Suite 533, Central Mall Plaza Suites #533,
Fort Smith, AR 72903
Ph: (479) 651-7413 |
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