Doctor Name: | MRS. CONNIE S. WALLACE |
NPI Number: | 1851592711 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | M.A., CCC |
License Number: | 513 |
Business Practice Address: | 10063 Irish Way Union, KY - 410917103 |
Business Phone Number: | 8593849339 |
Business Fax Number: | |
Mailing Address: | 10063 Irish Way, UNION |
State: | KY |
Postal Code: | 410917103 |
Phone Number: | 8593849339 |
Fax Number: | |
NPI Enumeration Date: | 05/29/2007 |
NPI Last Update Date: | 06/24/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | 513 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | KY |
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 |