Individual
CARRIE ANNE WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
285 W 800 S, ROOSEVELT, UT 84066-3707
(435) 725-6300
Mailing address
1140 W 500 S STE 9, VERNAL, UT 84078-2912
(435) 789-6300
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
—
—
Other
Enumeration date
06/18/2019
Last updated
06/18/2019
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