JUANITA WALLACE

FLORISSANT, MO
NPI1326164278
Entity TypeIndividual
GenderFemale
Sole Proprietor ?Yes
Primary Taxonomy101YM0800X Counselor, Mental Health
(Licence: MO  2002006418)
Enumeration Date2007-03-22
Last Update Date2007-07-09
Business Address
-- JUANITA WALLACE
570 SHACKELFORD RD
FLORISSANT, MO 63031-5457
Phone number: 314-583-0549
Mailing Address
-- JUANITA WALLACE
570 SHACKELFORD RD ROAD
FLORISSANT, MO 63031-5457
Phone number: 314-583-0549
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