Individual ProviderDionne WallaceSocial WorkerBehavioral Health & Social Service ProvidersPractice Address1010 Auburn Ave, Lafayette, LA 70503-2308(337) 261-2300(318) 459-6795PECOS EnrollmentBased on the most recent information from CMS, provider Dionne Wallace is legally eligible to order and refer claims for Part B and DME services only.Part BMedicare Part BEnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records today at 11:00 AM.Profile DetailsProvider ID1487948568Provider TypeIndividualFull NameWallace, DionneGenderFemaleSole ProprietorNoEnumeration Date6/6/2011Last Updated5/30/2024Contact InformationPractice LocationPractice Address1010 Auburn Ave, Lafayette, LA 70503-2308Phone(337) 261-2300Fax(337) 261-9080Mailing LocationMailing Address1000 Chinaberry Dr Ste 900, Bossier City, LA 71111-2455Phone(318) 459-6795Fax(318) 626-5429Provider TaxonomiesCodeDescriptionLicenseCode1041C0700XPrimaryDescriptionSocial WorkerBehavioral Health & Social Service ProvidersLicenseIC-1329Nevada