MEDICARE: DIANA WALLACE LCSW

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
1	1041C0700X	Clinical Social Worker	005144	CT
2	1041C0700X	Clinical Social Worker	3632	KY

General Provider Information

NPI Number	:	1336145432
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANA WALLACE LCSW

Provider Business Mailing Address
First Line	:	1 NUNN DR
Second Line	:	UNIVERSITY CENTER, SUITE 440
City	:	NEWPORT
State	:	KY
Zip	:	41099-0002
Country	:	US
Telephone Number	:	859-572-5650
Fax Number	:	859-572-5615

Provider Business Practice Location Address
First Line	:	1 NUNN DR
Second Line	:	UNIVERSITY CENTER, SUITE 440
City	:	NEWPORT
State	:	KY
Zip	:	41099-0002
Country	:	US
Telephone Number	:	859-572-5650
Fax Number	:	859-572-5615

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/23/2005
Last Update Date	:	06/12/2012

Similar Medicare Providers

1629928726 — MRS. HANNAH JOY MILLER
Practice Location Address:

1 NUNN DR
NEWPORT, KY
41099-0002

Practice Phone: 859-572-5220
Practice Fax:

1336905090 — EMMA BROOKS THOMAS MS, LAT, ATC
Practice Location Address:

1 NUNN DR
NEWPORT, KY
41099-0002

Practice Phone: 270-438-8436
Practice Fax: 859-572-1565

1467295881 — MRS. HAILEY STUCK MSN APRN FNP-C
Practice Location Address:

1 NUNN DR
NEWPORT, KY
41099-0002

Practice Phone: 859-572-5100
Practice Fax:

1518996636 — JOAN ZIEGELMEYER A.R.N.P.
Practice Location Address:

206 ALBRIGHT HEALTH CTR , NORTHERN KENTUCKY UNIVERSITY
NEWPORT, KY
41099-0001

Practice Phone: 885-957-2557
Practice Fax: 859-572-1934

1194123687 — NORTHERN KENTUCKY UNIVERSITY FOUNDATION INC.
Practice Location Address:

206 ALBRIGHT HEALTH CTR , NORTHERN KY UNIVERSITY
NEWPORT, KY
41099-0001

Practice Phone: 859-572-5579
Practice Fax: 859-572-1934

1891285441 — MOLLY WOODS
Practice Location Address:

500 LOUIE B NUNN DRIVE
NEWPORT, KY
41099-0001

Practice Phone: 859-572-1487
Practice Fax:

Directions to “ DIANA WALLACE LCSW” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.