Doctor Name: | BARBARA J WALLACE |
NPI Number: | 1255736955 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LICSW |
License Number: | LW00005711 |
Business Practice Address: | 1007 Koala Dr. Omak, WA - 98841 |
Business Phone Number: | 5098266191 |
Business Fax Number: | 5098268416 |
Mailing Address: | 1007 Koala Dr., OMAK |
State: | WA |
Postal Code: | 98841 |
Phone Number: | 5098266191 |
Fax Number: | 5098268416 |
NPI Enumeration Date: | 10/24/2014 |
NPI Last Update Date: | 10/24/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | LW00005711 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |