Individual
DR. JESSICA WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHD, AT, ATC
Contact information
Practice address
1 UNIVERSITY PLZ, YOUNGSTOWN, OH 44555-0001
(330) 941-2577
Mailing address
1 UNIVERSITY PLZ, YOUNGSTOWN, OH 44555-0001
(330) 941-2577
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AT004914
OH
Other
Enumeration date
09/17/2017
Last updated
07/21/2022
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