Individual
KENDRICK WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
B.A.
Contact information
Practice address
940 AVENUE 64, PASADENA, CA 91105-2711
(323) 254-2274
Mailing address
940 AVENUE 64, PASADENA, CA 91105-2711
(323) 254-2274
Taxonomy
Speciality
Code
Description
License number
State
225C00000X
Rehabilitation Counselor
Primary
—
—
Other
Enumeration date
06/06/2007
Last updated
08/09/2007
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