Individual
CODIE WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSW
Contact information
Practice address
2510 E 15TH ST, SUITE 11, CASPER, WY 82609-4111
(307) 234-9979
(307) 234-9989
Mailing address
2510 E 15TH ST, SUITE 11, CASPER, WY 82609-4111
(307) 234-9979
(307) 234-9989
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LCSW 800
WY
171M00000X
Case Manager/Care Coordinator
—
—
Other
Enumeration date
01/06/2009
Last updated
09/21/2012
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