Doctor Name: | MS. VONDA S. WALLACE-MACK |
NPI Number: | 1417089947 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | M.A.,CCC-SLP |
License Number: | 2986 |
Business Practice Address: | 4922 Dayspring Dr Mint Hill, NC - 282279305 |
Business Phone Number: | 7046490733 |
Business Fax Number: | |
Mailing Address: | 4922 Dayspring Dr, MINT HILL |
State: | NC |
Postal Code: | 282279305 |
Phone Number: | 7046490733 |
Fax Number: | |
NPI Enumeration Date: | 03/10/2007 |
NPI Last Update Date: | 01/06/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | 2986 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NC |
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 |