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

Mr. Kenneth Walter Wallace

Individual provider Student in an Organized Health Care Education/Training Program · NPI 1144078239

Mr. Kenneth Walter Wallace is a Student in an Organized Health Care Education/Training Program in Cleveland, Ohio. Registered with an NPI since 2024.

In the registry since
2024

Practice location Address checks out

11075 E Blvd
Cleveland, OH 44106-5409
Phone: (216) 368-2766
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Student in an Organized Health Care Education/Training Program (primary) Taxonomy 390200000X

Record details

NPI number1144078239
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorNo
NPI enumeratedMay 13, 2024
Last updated in NPPESMay 13, 2024
Certification dateMay 13, 2024
Mailing address2300 Overlook Rd Apt 110, Cleveland Heights, OH 44106-2346

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