IndividualActive
Richard Wallace, LICAC
NPI 1750458402 · Nutritionist · Great Falls, MT
Provider details
- NPI number
- 1750458402
- Entity type
- Individual
- Primary specialty
- NutritionistDietary & Nutritional Service Providers
- Credential
- LICAC
- Sex
- Male
- Sole proprietor
- No
- License
- 450 (MT)
Specialties & taxonomies
Dietary & Nutritional Service Providers
Dietary & Nutritional Service Providers
Other Service Providers
Practice location
914 13th Ave South
Great Falls, MT 59405
Phone: (406) 761-3767
Fax: (406) 761-3038
Approximate (ZIP-level) locationGet directions
Mailing address
914 13th Ave South
Great Falls, MT 59405
Registry dates
- Enumerated
- 2006-11-29
- Last updated
- 2025-09-11
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.