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Individual
REBECCA ELIZABETH WALLACE
Active
Individual
REBECCA ELIZABETH WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPES
Taxonomy
Speciality
Code
Description
License number
State
103TS0200X
School Psychologist
Primary
4797
SC
Other
Enumeration date
03/30/2023
Last updated
11/19/2023
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