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Contact Information

JENNIFER WALLACE
3409 MCDOUGALL AVE STE 200
EVERETT, WA98201-5040
 Phone: 480-685-7530
 Fax: 480-900-8853
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Phlebotomy

246RP1900X
 

Clinic/Center

261Q00000X
 

Clinical Medical Laboratory

291U00000X 69 Clinical Laboratory
 

Driver

172A00000X
 

Health Service

261QH0100X
 

Home Health

251E00000X A4[11] Home Health Agency
 

Home Health Aide

374U00000X
 

Nursing Care

251J00000X
 

Technician, Other

247200000X 75 Slide Preparation Facility
 

Technician/Technologist

156F00000X
Indicates primary specialty

NPI Profile & details for JENNIFER WALLACE · (Female)

NPI # 1356968440
Status Active
Credentials
Entity Individual
Enumeration date 07/06/2020
Last updated 04/14/2026 - About 2 months ago
Sole proprietor 1 Yes
Identifiers
  • AZ License # 032016
  • AZ License # 03D2197602
  • AZ License # 1568068609
  • AZ License # EXPERIENCED
  • WA License # PC61547365
  • WA License # WDL722Z7B13B
  • WA Other 50D2322596 CLIA
  • WA Other MTSW.FS.61686172 MEDICAL TEST SITE CLIA
  • WA Other PC61547365 PHLEBOTOMY LICENSE
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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