Individual
MS. MARISSA STEEN WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LSW
Contact information
Practice address
4251 KIPLING ST UNIT 560, WHEAT RIDGE, CO 80033-6800
(720) 490-7911
Mailing address
1750 30TH ST # 435, BOULDER, CO 80301-1029
(817) 734-6961
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
LSW.0009921712
CO
Other
Enumeration date
12/04/2019
Last updated
12/04/2019
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