Individual provider · Type 1 NPI

Kenneth Walter Wallace

Student in an Organized Health Care Education/Training Program · Cleveland, OH

NPI number 1144078239 Active

Practice location

11075 East Blvd
Cleveland, OH 44106-5409

Call (216) 368-2766 Map

Mailing address

2300 Overlook Rd Apt 110
Cleveland Heights, OH 44106-2346

Specialties and licenses

TaxonomyCodeLicense
Student in an Organized Health Care Education/Training Program Primary 390200000XNone listed

Student in an Organized Health Care Education/Training Program: An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.

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About NPI 1144078239

Kenneth Walter Wallace's National Provider Identifier is 1144078239, issued on May 13, 2024. The primary taxonomy on file is Student in an Organized Health Care Education/Training Program (390200000X), and the practice location is in Cleveland, OH. The record was last updated on May 13, 2024.