| NPI | 1104078765 |
|---|---|
| Former Name | HALLIE E WALLACE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MO 2005002602) |
| 1041C0700X Social Worker, Clinical (Licence: FL SW9397) | |
| Enumeration Date | 2008-10-15 |
| Last Update Date | 2015-09-29 |