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

Kaitlynn Wallace

Individual provider Student in an Organized Health Care Education/Training Program · NPI 1790249100

Kaitlynn Wallace is a Student in an Organized Health Care Education/Training Program in Portales, New Mexico. Licensed in California. Registered with an NPI since 2019.

Licensed in
CA
In the registry since
2019
Specialties on file
3
Claim this listing Report a problem Suggest an edit

Practice location Address checks out

1500 S Ave K Station 3 Shroc
Portales, NM 88130
Phone: (575) 562-2156
Show map & directions

Directions in Google Maps · Apple Maps · OpenStreetMap

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

Specialties & licences

Speech-Language Pathologist (primary) Taxonomy 235Z00000X
Student in an Organized Health Care Education/Training Program Taxonomy 390200000X (CA)
Student in an Organized Health Care Education/Training Program Taxonomy 390200000X

Record details

NPI number1790249100
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorNo
NPI enumeratedJanuary 30, 2019
Last updated in NPPESJuly 27, 2021
Certification dateJuly 27, 2021
Mailing address3319 E Forest Lake Rd, Acampo, CA 95220-9573

Other providers in Portales