Individual
JOHN F WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
3600 30TH ST, DES MOINES, IA 50310-5753
(515) 699-5999
Mailing address
3600 30TH ST, DES MOINES, IA 50310-5753
(515) 699-5999
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
775
IA
Other
Enumeration date
08/31/2006
Last updated
04/09/2009
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