Doctor Name: | MRS. J'AIME ELIZABETH WALLACE |
NPI Number: | 1093929028 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MCD, CCC-SLP |
License Number: | 22004132A |
Business Practice Address: | 102 E Culver Rd Knox, IN - 465342216 |
Business Phone Number: | 5747726231 |
Business Fax Number: | 5747721201 |
Mailing Address: | 102 E Culver Rd, P.o. Box 339 KNOX |
State: | IN |
Postal Code: | 465342216 |
Phone Number: | 5747726231 |
Fax Number: | 5747721201 |
NPI Enumeration Date: | 05/09/2007 |
NPI Last Update Date: | 07/09/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | 22004132A |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IN |
Taxonomy Type: | Speech, Language and Hearing Service Providers |
Taxonomy Classification: | Speech-Language Pathologist |
Taxonomy Specialization: | |
Taxonomy Definition: | A speech pathologist is a person qualified by a master |