MEDICARE: LILLIAN RENEE WALLIS

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	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1639009046
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LILLIAN RENEE WALLIS

Provider Business Mailing Address
First Line	:	55245 TIMOTHY RD
Second Line	:
City	:	NEW CARLISLE
State	:	IN
Zip	:	46552-9669
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3838 N MAIN ST
Second Line	:
City	:	MISHAWAKA
State	:	IN
Zip	:	46545-3100
Country	:	US
Telephone Number	:	888-982-5228
Fax Number	:

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

Provider Enumeration Date	:	05/20/2026
Last Update Date	:	05/20/2026

Similar Medicare Providers

1992960850 — DR. AERIE CHUNG MD
Practice Location Address:

3838 N MAIN ST STE 1C
MISHAWAKA, IN
46545-3100

Practice Phone: 574-404-3980
Practice Fax: 574-931-8601

1366097016 — MIDS, LLC
Practice Location Address:

3838 N MAIN ST STE 1C
MISHAWAKA, IN
46545-3100

Practice Phone: 574-404-3980
Practice Fax: 574-931-8601

1972115483 — MEDICAL SERVICE COMPANY
Practice Location Address:

3838 N MAIN ST STE 1B
MISHAWAKA, IN
46545-3100

Practice Phone: 866-907-5337
Practice Fax: 440-232-3411

1477484426 — JENNIFER HANN
Practice Location Address:

418 E MISHAWAKA AVE
MISHAWAKA, IN
46545-6820

Practice Phone: 574-323-0922
Practice Fax:

1720131543 — THE CENTER FOR HOSPICE AND PALLIATIVE CARE, INC
Practice Location Address:

501 COMFORT PL
MISHAWAKA, IN
46545-5234

Practice Phone: 574-243-3100
Practice Fax: 574-243-3134

1700090602 — DR. ERIC DAVID KNAPP D.O.
Practice Location Address:

611 E DOUGLAS RD STE 207
MISHAWAKA, IN
46545-1465

Practice Phone: 574-335-6850
Practice Fax: 574-335-0849

Directions to “ LILLIAN RENEE WALLIS ” 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.