Individual
ASHLI KEANAN WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2107 ESSEX LN, COLORADO SPRINGS, CO 80909-1425
(808) 778-0777
Mailing address
2107 ESSEX LN, COLORADO SPRINGS, CO 80909-1425
(808) 778-0777
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
AC-1241-33397408
CO
Other
Enumeration date
05/30/2024
Last updated
01/02/2025
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