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Individual

MR. KEITH V. WALLACE

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
L.C.S.W.

Contact information

Practice address
CHILDREN'S MEMORIAL HOSPITAL, 2300 CHILDREN'S PLAZA, BOX 10, CHICAGO, IL 60614
(773) 975-8604
Mailing address
CHILDREN'S MEMORIAL HOSPITAL, 2300 CHILDREN'S PLAZA, BOX 10, CHICAGO, IL 60614
(773) 975-8604

Taxonomy

Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
149-012034
IL

Other

Enumeration date
01/24/2007
Last updated
10/27/2008
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