Individual
LINDA M. WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CCC-A
Contact information
Practice address
1611 CAMBRIDGE ST, CAMBRIDGE, MA 02138-4302
(617) 661-5525
Mailing address
133 BROOKLINE AVE, BOSTON, MA 02215-3904
(617) 421-5984
Taxonomy
Speciality
Code
Description
License number
State
231H00000X
Audiologist
Primary
388
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0014863
NEIGHBORHOOD HEALTH PLAN
MA
05
—
5103053
—
MA
01
—
AD0161
BLUE CROSS
MA
01
—
B501027
CIGNA
MA
01
—
PJ183
HARVARD PILGRIM
MA
Enumeration date
01/26/2006
Last updated
10/26/2009
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