Individual
EILEEN L WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2701 LYN PL, BOWIE, MD 20715-2362
(301) 602-9121
Mailing address
2701 LYN PL, BOWIE, MD 20715-2362
(301) 602-9121
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
02805
MD
Other
Enumeration date
10/18/2022
Last updated
10/18/2022
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