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

Individual provider Clinical Social Worker · NPI 1295257624

Ty Lamar Wallace, MSW is a Clinical Social Worker in Pinckneyville, Illinois. Practices as a sole proprietor. Licensed in Illinois.

Licensed in
IL
In the registry since
2017
What do these letters mean?
MSW — Master of Social Work
The graduate degree in social work.

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Practice location Address checks out

4904 Bowls Bottom Rd
Pinckneyville, IL 62274-2453
Phone: (618) 926-6050
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Clinical Social Worker (primary) Taxonomy 1041C0700X · Licence 149-010121 (IL)

Record details

NPI number1295257624
Entity typeIndividual (Type 1)
GenderMale
Credentials MSW
Sole proprietorYes
NPI enumeratedJuly 7, 2017
Last updated in NPPESJuly 21, 2022

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