Individual
SIMONE WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1044 27TH AVE SE APT D, MINNEAPOLIS, MN 55414-2736
(612) 508-9723
Mailing address
1044 27TH AVE SE APT D, MINNEAPOLIS, MN 55414-2736
(612) 508-9723
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
04/13/2023
Last updated
04/13/2023
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