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

Nichole Wallace

Individual provider Clinical Social Worker · NPI 1407546229

Nichole Wallace is a Clinical Social Worker in Grand Rapids, Michigan. Practices as a sole proprietor. Licensed in Michigan.

Licensed in
MI
In the registry since
2023

Practice location Address checks out

678 Frnt Ave NW Ste 100
Grand Rapids, MI 49504-5323
Phone: (616) 916-3711
Show map & directions

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

Specialties & licences

Clinical Social Worker (primary) Taxonomy 1041C0700X · Licence 6851116253 (MI)

Record details

NPI number1407546229
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorYes
NPI enumeratedMay 15, 2023
Last updated in NPPESMay 15, 2023
Certification dateMay 15, 2023

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