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

Kristin Wallace

Individual provider Clinical Social Worker · NPI 1154931129

Kristin Wallace is a Clinical Social Worker in Madison, Mississippi. Practices as a sole proprietor. Licensed in Mississippi.

Licensed in
MS
In the registry since
2020
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Practice location Address checks out

940 Ebenezer Blvd
Madison, MS 39110-6002
Phone: (601) 790-0583
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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 M8300 (MS)

Record details

NPI number1154931129
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorYes
NPI enumeratedAugust 5, 2020
Last updated in NPPESAugust 5, 2020
Certification dateAugust 5, 2020
Mailing address437 Pin Oak Dr, Madison, MS 39110-9365

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