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1295438893
KRYSTAL JACQUELYN WALLACE
NEW ALBANY, IN
NPI
1295438893
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
Yes
Primary Taxonomy
104100000X Social Worker
Additional Taxonomies
101Y00000X Counselor
103K00000X Behavior Analyst
Enumeration Date
2023-03-23
Last Update Date
2023-03-23
Business Address
KRYSTAL JACQUELYN WALLACE MS MA BC
618 E MARKET ST
NEW ALBANY, IN 47150-2914
Phone number: 502-579-1278
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Mailing Address
KRYSTAL JACQUELYN WALLACE MS MA BC
2704 ALLSTON AVE
LOUISVILLE, KY 40210-2004
Phone number: 708-699-5619
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