Provider Demographics
NPI:1205630464
Name:WALLACE, KATHRYN LEAF (DOULA)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:LEAF
Last Name:WALLACE
Suffix:
Gender:
Credentials:DOULA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 WEDGEWOOD LN
Mailing Address - Street 2:
Mailing Address - City:BARRINGTON
Mailing Address - State:RI
Mailing Address - Zip Code:02806-3218
Mailing Address - Country:US
Mailing Address - Phone:860-428-0217
Mailing Address - Fax:
Practice Address - Street 1:9 WEDGEWOOD LN
Practice Address - Street 2:
Practice Address - City:BARRINGTON
Practice Address - State:RI
Practice Address - Zip Code:02806-3218
Practice Address - Country:US
Practice Address - Phone:781-296-4359
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-04
Last Update Date:2025-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula