Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Jennifer Lynn Hataway-Wallace, LCSW

Individual provider Clinical Social Worker · NPI 1255996617

Jennifer Lynn Hataway-Wallace, LCSW is a Clinical Social Worker in Fort Meade, South Dakota. Licensed in South Dakota. Registered with an NPI since 2019.

Licensed in
SD
In the registry since
2019
What do these letters mean?
LCSW — Licensed Clinical Social Worker
A social worker licensed to diagnose and treat mental health conditions independently.

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Practice location Address checks out

113 Comanche Rd
Fort Meade, SD 57741-1002
Phone: (605) 720-7422
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Clinical Social Worker (primary) Taxonomy 1041C0700X · Licence 3589 (SD)

Record details

NPI number1255996617
Entity typeIndividual (Type 1)
GenderFemale
Credentials LCSW
Sole proprietorNo
NPI enumeratedMay 1, 2019
Last updated in NPPESMay 1, 2019

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