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1205483849
JENNIFER WALLACE
PALMDALE, CA
NPI
1205483849
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
101YA0400X Counselor, Addiction (Substance Use Disorder)
(Licence: Ci21770419)
Enumeration Date
2019-08-19
Last Update Date
2019-08-19
Business Address
JENNIFER WALLACE
320 E PALMDALE BLVD
PALMDALE, CA 93550-4598
Phone number: 661-729-9000
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Mailing Address
JENNIFER WALLACE
43415 20TH ST W APT 21
LANCASTER, CA 93534-5964
Phone number: 661-754-1550
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