| Doctor Name: | ELIZABETH WALLACE |
| NPI Number: | 1104033513 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PH.D., CCC |
| License Number: | 14038 |
| Business Practice Address: | 8215 Westchester Drive Suite 234 Dallas, TX - 752256103 |
| Business Phone Number: | 2143688251 |
| Business Fax Number: | 2143687765 |
| Mailing Address: | 8215 Westchester Dr, Suite 234 DALLAS |
| State: | TX |
| Postal Code: | 752256103 |
| Phone Number: | 2143688251 |
| Fax Number: | 2143687765 |
| NPI Enumeration Date: | 05/16/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 235Z00000X |
| License Number: | 14038 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TX |
| 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 |