| NPI | 1114319092 |
|---|---|
| Professional Name | KATHLEEN JENNIFER WALLACE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: IL 180.009256) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MO 2013036985) |
| 101YP2500X Counselor, Professional (Licence: IL Il#180.009256) | |
| Enumeration Date | 2015-03-02 |
| Last Update Date | 2022-02-02 |