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NPI Code Detail

MEDICARE: REESE WALLACE

MEDICARE: REESE 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
1106S00000XBehavior TechnicianRBT-25-497953KS

General Provider Information

NPI Number : 1235093576
Entity Type Code : Individual
Provider Name (Legal Business Name) : REESE WALLACE
Provider Business Mailing Address
First Line : 9100 W 74TH ST
Second Line :
City : MERRIAM
State : KS
Zip : 66204-4004
Country : US
Telephone Number : 913-676-2000
Fax Number :
Provider Business Practice Location Address
First Line : 9100 W 74TH ST
Second Line :
City : MERRIAM
State : KS
Zip : 66204-4004
Country : US
Telephone Number : 913-676-2000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/11/2025
Last Update Date : 12/11/2025

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Directions to “ REESE WALLACE ” Practice Location

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