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1699042788
BENNETT ALLAN WALLACE
LOUISVILLE, KY
NPI
1699042788
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
1041C0700X Social Worker, Clinical
(Licence: KY 3772)
Enumeration Date
2011-11-17
Last Update Date
2011-11-17
Business Address
Mr. BENNETT ALLAN WALLACE M.S.S.W
164 E ASHLAND AVE
LOUISVILLE, KY 40214-1908
Phone number: 502-693-2606
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Mailing Address
Mr. BENNETT ALLAN WALLACE M.S.S.W
164 E ASHLAND AVE
LOUISVILLE, KY 40214-1908
Phone number: 502-693-2606
Copy
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