| Doctor Name: | BRADLEY WALLACE |
| NPI Number: | 1578839981 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | |
| License Number: | |
| Business Practice Address: | 6175 Cahill Ave Ste. 103 Inver Grove Heights, MN - 550765501 |
| Business Phone Number: | 6519677753 |
| Business Fax Number: | |
| Mailing Address: | 8800 Se Sunnyside Rd, Ste. 300-n CLACKAMAS |
| State: | OR |
| Postal Code: | 970155738 |
| Phone Number: | 5036595115 |
| Fax Number: | |
| NPI Enumeration Date: | 03/29/2012 |
| NPI Last Update Date: | 03/29/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 237600000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Speech, Language and Hearing Service Providers |
| Taxonomy Classification: | Audiologist-Hearing Aid Fitter |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An audiologist/hearing aid fitter is the professional who specializes in evaluating and treating people with hearing loss, conducts a wide variety of tests to determine the exact nature of an individual |