Provider Demographics
NPI:1356232607
Name:MCGUIRE-WALLACE, EMILY
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:MCGUIRE-WALLACE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5219 N SHIRLEY ST STE 100
Mailing Address - Street 2:
Mailing Address - City:RUSTON
Mailing Address - State:WA
Mailing Address - Zip Code:98407-6599
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5219 N SHIRLEY ST STE 100
Practice Address - Street 2:
Practice Address - City:RUSTON
Practice Address - State:WA
Practice Address - Zip Code:98407-6599
Practice Address - Country:US
Practice Address - Phone:253-434-4200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-14
Last Update Date:2025-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW613875601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical