Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Jackie Wallace, CRPA

Individual provider Peer Specialist · NPI 1609751080

Jackie Wallace, CRPA is a Peer Specialist in Rochester, New York. Practices as a sole proprietor. Licensed in New York.

Licensed in
NY
In the registry since
2025

Practice location Address checks out

2069 Hudson Ave D
Rochester, NY 14617
Phone: (585) 694-1307
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Peer Specialist (primary) Taxonomy 175T00000X (NY)

Record details

NPI number1609751080
Entity typeIndividual (Type 1)
GenderMale
Credentials CRPA
Sole proprietorYes
NPI enumeratedAugust 6, 2025
Last updated in NPPESAugust 6, 2025
Certification dateAugust 1, 2025

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