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

Mr. Keith V Wallace, LCSW

Individual provider Social Worker · NPI 1104971712

Mr. Keith V Wallace, LCSW is a Social Worker in Chicago, Illinois. Practices as a sole proprietor. Licensed in Illinois.

Licensed in
IL
In the registry since
2007
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 Partly verified

Some contact details are missing from the federal record.

Children's Memorial Hospital 2300 Children's Plaza Box 10
Chicago, IL 60614
Phone: (773) 975-8604
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Social Worker (primary) Taxonomy 104100000X · Licence 149-012034 (IL)

Record details

NPI number1104971712
Entity typeIndividual (Type 1)
GenderMale
Credentials LCSW
Sole proprietorYes
NPI enumeratedJanuary 24, 2007
Last updated in NPPESOctober 27, 2008

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