| NPI | 1174183941 |
|---|---|
| Former Name | LINDSEY RENEE WALLACE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NY 024713) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| Enumeration Date | 2019-06-14 |
| Last Update Date | 2022-04-25 |