Individual
MARY BETH WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CCC-SLP
Contact information
Practice address
2461 HIGHWAY 1, HARRISBURG, AR 72432-9479
(870) 578-2763
Mailing address
2461 HIGHWAY 1, HARRISBURG, AR 72432-9479
(870) 578-2763
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
1978
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
148690721
—
AR
Enumeration date
03/16/2007
Last updated
08/14/2017
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