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General NPI Number Information
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NPI Number | 1225937832
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Entity Type | Individual
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Provider Name | DANIELLE WALLACE
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Gender | Female
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Dates
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Enumeration Date | 11/02/2026
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Last Update Date | 11/02/2026
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Provider Practice Location Address
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Address Line | 1338 S FOOTHILL DR # 333
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City | SALT LAKE CITY
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State | UT
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Zip | 84108-2321
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Country | US
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Telephone | 801-754-6051
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Fax | 801-210-0476
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Provider Business Mailing Address
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Address Line | 15 ROXBURY DR
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City | SAVANNAH
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State | GA
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Zip | 31407-1167
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Country | US
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Telephone | 801-754-6051
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Fax | 801-210-0476
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State | UT
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