MEDICARE: VALENCIA 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
1	104100000X	Social Worker

General Provider Information

NPI Number	:	1073479937
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VALENCIA WALLACE

Provider Business Mailing Address
First Line	:	2830 E 25TH ST
Second Line	:
City	:	GRANITE CITY
State	:	IL
Zip	:	62040-5934
Country	:	US
Telephone Number	:	618-419-3363
Fax Number	:

Provider Business Practice Location Address
First Line	:	2830 E 25TH ST
Second Line	:
City	:	GRANITE CITY
State	:	IL
Zip	:	62040-5934
Country	:	US
Telephone Number	:	618-419-3363
Fax Number	:

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

Provider Enumeration Date	:	01/05/2026
Last Update Date	:	01/05/2026

Similar Medicare Providers

1326186891 — DR. FRANCISCO XAVIER CERVANTES SR. DDS
Practice Location Address:

4060 DOUGLAS BLVD STE 110
GRANITE BAY, CA
95746-5934

Practice Phone: 916-789-2273
Practice Fax: 916-789-2010

1760685069 — DR. RONALD E GEIGER D.C.
Practice Location Address:

4060 DOUGLAS BLVD , #104
GRANITE BAY, CA
95746-5934

Practice Phone: 916-791-7900
Practice Fax: 916-797-2642

1134716939 — TAVALLAEI, D.M.D., CORPORATION
Practice Location Address:

4060 DOUGLAS BLVD STE 110
GRANITE BAY, CA
95746-5934

Practice Phone: 916-260-0646
Practice Fax:

1154918944 — S. JANG DDS INCORPORATED
Practice Location Address:

4060 DOUGLAS BLVD STE 110
GRANITE BAY, CA
95746-5934

Practice Phone: 916-260-0704
Practice Fax:

1770821308 — MS. KELLY ELIZABETH MOHEN
Practice Location Address:

112 4TH ST
GARDEN CITY, NY
11530-5934

Practice Phone: 516-581-8204
Practice Fax:

1154866374 — MOLLY LYN ANDERSON WHNP-BC
Practice Location Address:

1005 SPRING CITY DR
WAUKESHA, WI
53186-5934

Practice Phone: 262-301-2020
Practice Fax:

Directions to “ VALENCIA WALLACE ” 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.