| Doctor Name: | SHAYLA WALLACE |
| NPI Number: | 1639480627 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MSP, CCC-SLP |
| License Number: | 9030 |
| Business Practice Address: | 5 Dowd Cir Suite A Pinehurst, NC - 283747901 |
| Business Phone Number: | 9102952609 |
| Business Fax Number: | |
| Mailing Address: | 300 Prospect St, SOUTHERN PINES |
| State: | NC |
| Postal Code: | 283876471 |
| Phone Number: | 8038403411 |
| Fax Number: | |
| NPI Enumeration Date: | 06/24/2010 |
| NPI Last Update Date: | 06/24/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 235Z00000X |
| License Number: | 9030 |
| 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 |