Individual
DR. SUSAN 'SUZI' WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHD, PT, LPC
Contact information
Practice address
5111 ROGERS AVENUE, SUITE 533, CENTRAL MALL PLAZA SUITES #533, FORT SMITH, AR 72903
(479) 651-7413
Mailing address
4711 OAK HOLLOW LANE, FORT SMITH, AR 72903
(479) 651-7413
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
A0510074
AR
103TC0700X
Clinical Psychologist
Primary
18-08P
AR
225100000X
Physical Therapist
1724
AR
Other
Enumeration date
10/03/2007
Last updated
08/30/2018
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