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1295083897
JENNIFER WALLACE
WEST BLOOMFIELD, MI
NPI
1295083897
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
103T00000X Psychologist
(Licence: MI 6301014813)
Enumeration Date
2012-08-29
Last Update Date
2012-08-29
Business Address
JENNIFER WALLACE
4226 GREEN LAKE RD
WEST BLOOMFIELD, MI 48323-1139
Phone number: 248-404-5616
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Mailing Address
JENNIFER WALLACE
4226 GREEN LAKE RD
WEST BLOOMFIELD, MI 48323-1139
Phone number: 248-404-5616
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