Individual provider · Type 1 NPI

Jackie Wallace, CRPA

Peer Specialist · Rochester, NY

NPI number 1609751080 Active

Practice location

2069 Hudson Ave., D
Rochester, NY 14617

Call (585) 694-1307 Map

Mailing address

150 Mt.hope Ave
Rochester, NY 14620

Specialties and licenses

TaxonomyCodeLicense
Peer Specialist Primary 175T00000XNone listed

Peer Specialist: Individuals certified to perform peer support services through a training process defined by a government agency, such as the Department of Veterans Affairs or a state mental health department/certification/licensing authority.

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About NPI 1609751080

Jackie Wallace, CRPA's National Provider Identifier is 1609751080, issued on Aug 6, 2025. The primary taxonomy on file is Peer Specialist (175T00000X), and the practice location is in Rochester, NY. The record was last updated on Aug 6, 2025.