Individual
ANN S WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS SPEECH PATHOLOGY
Contact information
Practice address
2620 RUSSELL LONG BLVD, VHAC 242, DEPT. OF COMM. DIS., CANYON, TX 79016-0001
(806) 651-5114
(806) 651-5105
Mailing address
PO BOX 60757, CANYON, TX 79016-0001
(806) 651-5114
(806) 651-5105
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
13774
TX
Other
Enumeration date
09/18/2009
Last updated
06/20/2012
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