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Jackie Wallace, CRPA
NPI 1609751080 · on the registry since 2025 · sole proprietor
Practice
- Address
- 2069 Hudson Ave.
D
Rochester, NY 14617 - Phone
- (585) 694-1307
Registry record
- Primary taxonomy
- Peer Specialist
175T00000X
- Licence states on file
- NY
From the registry's licence fields, which are often incomplete.
- Sex
- Male
- Record last updated
- 2025-08-06
Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in New York