Individual
JANA MICHELLE WALLEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CCC-SLP
Contact information
Practice address
3200 MESA WAY STE D, LAWRENCE, KS 66049-2343
(785) 831-3053
Mailing address
925 E 1279 RD, LAWRENCE, KS 66047-9612
(178) 533-1904
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
1622
KS
Other
Enumeration date
08/24/2021
Last updated
08/24/2021
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