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NPI Code Detail

MEDICARE: KASIE WALLACE

MEDICARE: KASIE WALLACE
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1306793021
Entity Type Code : Individual
Provider Name (Legal Business Name) : KASIE WALLACE
Provider Business Mailing Address
First Line : 115 ROCKWOOD LN
Second Line :
City : HAZARD
State : KY
Zip : 41701-9415
Country : US
Telephone Number : 800-575-7223
Fax Number : 606-436-5797
Provider Business Practice Location Address
First Line : 115 ROCKWOOD LN
Second Line :
City : HAZARD
State : KY
Zip : 41701-9415
Country : US
Telephone Number : 800-575-7223
Fax Number : 606-436-5797
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/12/2026
Last Update Date : 03/12/2026

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Directions to “ KASIE WALLACE ” Practice Location

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