Individual
MRS. GRETCHEN COLEMAN WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS, RD, LD, CD
Contact information
Practice address
6 CARDINAL WAY, SUITE 900, ST. LOUIS, MO 63102
(360) 209-2075
(206) 681-9640
Mailing address
6 CARDINAL WAY STE 900, ST. LOUIS, MO 63102
(360) 209-2075
(206) 681-9640
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
10235828
OR
133V00000X
Registered Dietitian
2023005984
MO
133V00000X
Registered Dietitian
Primary
DI60956654
WA
133V00000X
Registered Dietitian
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Other
Enumeration date
08/25/2017
Last updated
11/08/2023
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