Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Mr. Keith V Wallace, LCSW

Individual provider Social Worker · NPI 1104971712

Mr. Keith V Wallace, LCSW is a Social Worker in Chicago, Illinois. Practices as a sole proprietor. Licensed in Illinois.

Licensed in
IL
In the registry since
2007
What do these letters mean?
LCSW — Licensed Clinical Social Worker
A social worker licensed to diagnose and treat mental health conditions independently.

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Practice location Partly verified

Some contact details are missing from the federal record.

Children's Memorial Hospital 2300 Children's Plaza Box 10
Chicago, IL 60614 Not confirmed with CMS for 17 years — call before visiting
Phone: (773) 975-8604
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Social Worker (primary) Taxonomy 104100000X · Licence 149-012034 (IL)

Record details

NPI number1104971712
Entity typeIndividual (Type 1)
GenderMale
Credentials LCSW
Sole proprietorYes
NPI enumeratedJanuary 24, 2007
Last updated in NPPESOctober 27, 2008

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