DYLAN WALLACE (LCSW, QCSW) – Clinical Social Worker, NPI 1982269155
Clinical Social Worker
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
965 CLINICAL SOCIAL WORKER in UT
Provider Addresses for DYLAN WALLACE (LCSW, QCSW)
1469 N 1200 W
Orem, UT 840572449
Phone: (801) 655-5450
Fax: (385) 225-9327
Type: Location
1431, North 1200 West, Orem, Utah County, Utah, 84057, United States
OREM, UT 840572449
Phone: (970) 210-9643
Type: Mailing
1433 N 1200 W
Orem, UT 840572449
Phone: (801) 655-5450
Fax: (385) 225-9327
Type: Location
22232 17th Ave SE Ste 305
Bothell, WA 980217425
Phone: (801) 655-5450
Fax: (385) 225-9327
Type: Location
1800 Pembrook Dr Ste 300
Orlando, FL 328106378
Phone: (801) 655-5450
Fax: (385) 225-9327
Type: Location
3303 E Baseline Rd Ste 111
Gilbert, AZ 852342739
Phone: (801) 655-5450
Fax: (385) 225-9327
Type: Location
511 28th Ave E
Seattle, WA 981124161
Phone: (801) 655-5450
Fax: (385) 225-9327
Type: Location
34 MAIN STREET EXT STE 104
PLYMOUTH, MA 023603375
Phone: (801) 655-5450
Fax: (385) 225-9327
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2026-02-21
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking 3 Medicare enrollment records; no due dates published yet.
Enrollment records
3
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20240808001881 | I | Clinical Social Worker | MA | TBD |
| I20240918001759 | I | Clinical Social Worker | WA | TBD |
| I20260221000244 | I | Clinical Social Worker | UT | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 84057)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Clinical Social Worker | UT | |
| Marriage And Family Therapist | UT | |
| Mental Health Counselor | UT | |
| Clinical Social Worker | UT | |
| Clinical Social Worker | UT | |
| Clinical Social Worker | UT | |
| Marriage And Family Therapist | UT | |
| Mental Health Counselor | UT | |
| Clinical Social Worker | UT |
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