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1215691597
CANDACE NICOLE WALLIS
COOS BAY, OR
NPI
1215691597
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Former Name
CANDACE NICOLE RIEGER
Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
1041C0700X Social Worker, Clinical
(Licence: FL 15085)
Enumeration Date
2021-10-24
Last Update Date
2021-10-24
Business Address
CANDACE NICOLE WALLIS
125 CENTRAL AVE STE 290
COOS BAY, OR 97420-2342
Phone number: 541-267-2113
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Mailing Address
CANDACE NICOLE WALLIS
1600 WOODLAND DR
COOS BAY, OR 97420-2044
Phone number: 727-692-7373
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