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JACKIE WALLACE CRPA
NPI 1609751080
Peer Specialist in Rochester, NY

Active since August 06, 2025
2069 HUDSON AVE., D, ROCHESTER, NY 14617(585) 694-1307 Get Directions Write a Review

NPPES record last updated: August 6, 2025. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Jackie Wallace Crpa NPPES

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

JACKIE WALLACE CRPA (NPI 1609751080) is an individual peer specialist in Rochester, New York and active in the NPI registry since August 2025.

NPPES Registry Identity

NPI1609751080
Entity TypeIndividualMale
Primary Taxonomy175T00000X
Provider Legal NameJACKIE WALLACECredential: CRPA
Location Address2069 HUDSON AVE., DRochester, NY 14617
Mailing Address150 Mt.hope AveRochester, NY 14620 · (585) 706-7983
Phone(585) 694-1307
Sole ProprietorYes
Enumeration DateAugust 6, 2025
NPPES CertifiedAugust 1, 2025
✔ NPI 1609751080 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPeer SpecialistOther Service Providers
Taxonomy Code175T00000X
Definition
Individuals certified to perform peer support services through a training process defined by a government agency, such as the Department of Veterans Affairs or a state mental health department/certification/licensing authority.
2069 HUDSON AVE., Rochester, NY 14617
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Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Jackie Wallace's NPI number?

The NPI number for Jackie Wallace is 1609751080. It was assigned to this individual provider in the NPPES registry on August 6, 2025.

Where is Jackie Wallace located?

Jackie Wallace practices at 2069 Hudson Ave. D, Rochester, NY 14617. The listed phone number is (585) 694-1307.

What is Jackie Wallace's specialty?

The primary specialty registered for this NPI is Peer Specialist with taxonomy code 175T00000X.

When was this NPI record last updated?

The NPPES record for Jackie Wallace was last updated on August 6, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 12 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.