| NPI | 1982269155 |
|---|---|
| Other Name | DYLAN SHANE WALLACE |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MA LICSW126861) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: WA SWI.LW.61224850) |
| 1041C0700X Social Worker, Clinical (Licence: FL SW15210) | |
| 1041C0700X Social Worker, Clinical (Licence: ID 3381901) | |
| 1041C0700X Social Worker, Clinical (Licence: UT 11338410-3501) | |
| Enumeration Date | 2019-05-03 |
| Last Update Date | 2026-04-02 |