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Individual
MADISON WALLACE
Active
Individual
MADISON WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
—
—
235Z00000X
Speech-Language Pathologist
Primary
SP.16583
OH
Other
Enumeration date
06/18/2016
Last updated
08/01/2025
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