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Individual
KATHI WALLACE
Active
Individual
KATHI WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
L.C.P.C.
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
180.009256
IL
101YP2500X
Professional Counselor
2013036985
MO
101YP2500X
Professional Counselor
IL#180.009256
IL
Other
Enumeration date
03/02/2015
Last updated
02/02/2022
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