Individual
TARA WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
225 SW 12TH ST RM 205, TOPEKA, KS 66612-1310
(785) 633-9453
(785) 727-4006
Mailing address
325 SW FRAZIER AVE, TOPEKA, KS 66606-1963
(785) 232-5005
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
9072
KS
1041C0700X
Clinical Social Worker
Primary
4741
KS
Other
Enumeration date
01/28/2014
Last updated
06/27/2025
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