Individual
MISS TAMMY LYNN WALLS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1523 RITTER ST, APT. A, EDWARDSVILLE, IL 62025-1044
(618) 978-0690
Mailing address
1523 RITTER ST, APT. A, EDWARDSVILLE, IL 62025-1044
(618) 978-0690
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
—
—
Other
Enumeration date
04/14/2009
Last updated
04/14/2009
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