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NPI Code Detail

MEDICARE: CHLOE ABIGAIL WALLACE LSW

MEDICARE: CHLOE ABIGAIL WALLACE LSW
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
1104100000XSocial Worker150.108715IL

General Provider Information

NPI Number : 1528917796
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHLOE ABIGAIL WALLACE LSW
Provider Business Mailing Address
First Line : 50 NORTHGATE INDUSTRIAL DR
Second Line :
City : GRANITE CITY
State : IL
Zip : 62040-6805
Country : US
Telephone Number : 618-877-4420
Fax Number : 618-877-4420
Provider Business Practice Location Address
First Line : 50 NORTHGATE INDUSTRIAL DR
Second Line :
City : GRANITE CITY
State : IL
Zip : 62040-6805
Country : US
Telephone Number : 618-877-4420
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/22/2026
Last Update Date : 01/22/2026

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Directions to “ CHLOE ABIGAIL WALLACE LSW” Practice Location

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