MEDICARE: MELISSA EMILY WALLACE LCSW

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	1041C0700X	Clinical Social Worker	SW17470	FL

General Provider Information

NPI Number	:	1841656311
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA EMILY WALLACE LCSW

Provider Business Mailing Address
First Line	:	6700 S FLORIDA AVE STE 33
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33813-3312
Country	:	US
Telephone Number	:	863-450-3067
Fax Number	:	863-337-4123

Provider Business Practice Location Address
First Line	:	1473 CYPRESS VIEW LN
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33811-2689
Country	:	US
Telephone Number	:	863-899-7613
Fax Number	:

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

Provider Enumeration Date	:	01/13/2016
Last Update Date	:	02/15/2023

Similar Medicare Providers

1548733280 — JESSIE AMEDO PERLADO
Practice Location Address:

454 LAKE HARRIS DR
LAKELAND, FL
33813-2689

Practice Phone: 863-393-7222
Practice Fax:

1861194144 — PRIME TIME MEDICAL TRANSPORT LLC
Practice Location Address:

454 LAKE HARRIS DR
LAKELAND, FL
33813-2689

Practice Phone: 863-777-0833
Practice Fax: 863-583-0878

1396421939 — PRO2CALL MEDICAL TRANSPORT
Practice Location Address:

454 LAKE HARRIS DR
LAKELAND, FL
33813-2689

Practice Phone: 863-777-0833
Practice Fax:

1982422838 — PRO2CALL MEDICAL TRANSPORT
Practice Location Address:

454 LAKE HARRIS DR
LAKELAND, FL
33813-2689

Practice Phone: 863-393-7222
Practice Fax:

1659244820 — BUZZY BEE PEDIATRIC OT
Practice Location Address:

2689 PORTER ST
LAKELAND, FL
33810-5156

Practice Phone: 863-838-4025
Practice Fax:

1932042264 — SHANNON LINDSEY BURKE
Practice Location Address:

6902 POLEY CREEK DR E
LAKELAND, FL
33811-2465

Practice Phone: 863-388-9132
Practice Fax:

Directions to “ MELISSA EMILY WALLACE LCSW” 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.