DR. SUSAN 'SUZI' WALLACE PSYCHOLOGIST
NPI 1124215256
Psychologist - Clinical in Anchorage, AK

Q: What is Susan 'suzi' Wallace's NPI number?

The NPI number for Susan 'suzi' Wallace is 1124215256. It was assigned to this individual provider in the NPPES registry on October 3, 2007.

Q: What is Susan 'suzi' Wallace's specialty?

The primary specialty registered for this NPI is Psychologist, specializing in Clinical, with taxonomy code 103TC0700X.

Active since October 03, 2007PECOS Enrolled

4341 TUDOR CENTRE DR STE 300, ANCHORAGE, AK 99508(907) 729-2500 Get Directions Write a Review

NPPES record last updated: June 9, 2026. Verified against the NPPES registry weekly; last sync: November 01, 2026.

Record update history: Aug 30, 2018, Mar 17, 2018, Feb 12, 2018 (3 updates tracked since 2018).

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About Dr. Susan 'suzi' Wallace Psychologist NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. SUSAN 'SUZI' WALLACE PSYCHOLOGIST (NPI 1124215256) is an individual clinical provider in Anchorage, Alaska, licensed in Alaska (242882) and active in the NPI registry since October 2007. She is enrolled in Medicare PECOS, maintains 3 additional practice locations, and is a graduate of Other (2016).

NPPES Registry Identity

NPI1124215256

Entity TypeIndividualFemale

Primary Taxonomy103TC0700X

Provider Legal NameDR. SUSAN 'SUZI' WALLACECredential: PSYCHOLOGIST

Location Address4341 TUDOR CENTRE DR STE 300Anchorage, AK 99508-5904

Mailing Address7033 E Tudor RdAnchorage, AK 99507-1262 · (907) 729-6801 · Fax (907) 729-5180

Phone(907) 729-2500

Sole ProprietorYes

Medical School CMSOtherGraduated 2016

Enumeration DateOctober 3, 2007

Last NPPES UpdateJune 9, 20263 updates tracked since enumeration

NPPES CertifiedJune 9, 2026

✔ NPI 1124215256 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

★ Primary SpecialtyPsychologist · ClinicalBehavioral Health & Social Service Providers

Taxonomy Code103TC0700X

Licenses✔ Licensed in AK · 242882✔ Licensed in AR · 18-08P

Definition

A psychologist who provides continuing and comprehensive mental and behavioral health care for individuals and families; consultation to agencies and communities; training, education and supervision; and research-based practice. It is a specialty in breadth -- one that is broadly inclusive of severe psychopathology -- and marked by comprehensiveness and integration of knowledge and skill from a broad array of disciplines within and outside of psychology proper. The scope of clinical psychology encompasses all ages, multiple diversities and varied systems.

Also ListedCounselor · ProfessionalTaxonomy 101YP2500X · License A0510074 (AR)

Also ListedPhysical TherapistTaxonomy 225100000X · License 1724 (AR)

4341 TUDOR CENTRE DR STE 300, Anchorage, AK 99508

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Secondary Practice Locations 3

Location 14711 Oak Hollow LaneFort Smith, AR 72903 · Phone (479) 651-7413

Location 25111 Rogers Avenue, Suite 533, Central Mall Plaza Suites #533Fort Smith, AR 72903 · Phone (479) 651-7413

Location 33111 S 70th StFort Smith, AR 72903-5017 · Phone (479) 452-6650 · Fax (479) 785-9495

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Arkansas Health & Wellness, Ambetter from Louisiana Healthcare Connections, Ambetter from Superior HealthPlan and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Dr. Susan 'suzi' Wallace Psychologist is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID8628540135

PECOS Enrollment IDI20260616002644

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignment

Medicare enrollment records show Susan 'suzi' Wallace reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Southcentral Foundation

Same address

Multi-Specialty

4341 TUDOR CENTRE DR STE 200
Anchorage, AK 99508

Reassigned Medicare billing, Texas enrollment
459 clinicians in this Medicare group

NPI 1083660815 (907) 729-8500

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 99508 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$222.64 typical visit price

range $71.33 – $222.64

Typical copayment $55.66 (range $17.83 – $55.66)

Most-billed visit code 99205

Established Patient

$128.73 typical visit price

range $21.84 – $181.48

Typical copayment $32.18 (range $5.46 – $45.37)

Most-billed visit code 99214

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 14

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MS. BAHIYYIH ALEXANDRA YOUNG LPC

Counselor