Individual
KATI WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3 W BOONE ST, CLOVERDALE, IN 46120-9003
(812) 605-9748
Mailing address
3 W BOONE ST, CLOVERDALE, IN 46120-9003
(812) 605-9748
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
34010387A
IN
Other
Enumeration date
06/11/2024
Last updated
10/03/2025
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