Individual
EMILY MARISSA WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
6846 S CANTON AVE, TULSA, OK 74136-3412
(918) 806-0106
Mailing address
6846 S CANTON AVE, TULSA, OK 74136-3412
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
CF791
OK
Other
Enumeration date
06/09/2025
Last updated
03/24/2026
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