Individual
JUDITH WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MAC, LAT
Contact information
Practice address
1221 W 5TH ST, SHERIDAN, WY 82801-2701
(307) 674-4405
Mailing address
1221 W 5TH ST, SHERIDAN, WY 82801-2701
(307) 674-4405
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
352
WY
101YM0800X
Mental Health Counselor
1359
WY
101YP2500X
Professional Counselor
Primary
2478
WY
171100000X
Acupuncturist
A-030
WY
Other
Enumeration date
01/30/2017
Last updated
01/30/2026
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