MEDICARE: KAILA WALLACE DOULA

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	374J00000X	Doula	1230241401	IL

General Provider Information

NPI Number	:	1083487961
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAILA WALLACE DOULA

Provider Business Mailing Address
First Line	:	12685 DORSETT RD # 405
Second Line	:
City	:	MARYLAND HEIGHTS
State	:	MO
Zip	:	63043-2100
Country	:	US
Telephone Number	:	314-252-1933
Fax Number	:

Provider Business Practice Location Address
First Line	:	3407 S JEFFERSON AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63118-3119
Country	:	US
Telephone Number	:	314-252-1933
Fax Number	:

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

Provider Enumeration Date	:	11/02/2023
Last Update Date	:	12/03/2025

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