KAITLYNN WALLACE

PORTALES, NM
NPI1790249100
Entity TypeIndividual
GenderFemale
Sole Proprietor ?No
Primary Taxonomy235Z00000X Speech-Language Pathologist,
Additional Taxonomies390200000X Student in an Organized Health Care Education/Training Program
390200000X Student in an Organized Health Care Education/Training Program
Enumeration Date2019-01-30
Last Update Date2021-07-27
Business Address
KAITLYNN WALLACE
1500 S AVE K STATION 3, SHROC
PORTALES, NM 88130
Phone number: 575-562-2156
Mailing Address
KAITLYNN WALLACE
3319 E FOREST LAKE RD
ACAMPO, CA 95220-9573
Phone number: