Organization
WALLACE SPEECH THERAPY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PATTY NESOM WALLACE CCC-SLP (OWNER)
(254) 371-5479
Entity
Organization
Contact information
Practice address
460 BRIARCROFT LN, KILLEEN, TX 76542-5606
(254) 371-5479
Mailing address
460 BRIARCROFT LN, KILLEEN, TX 76542-5606
(254) 371-5479
Taxonomy
Speciality
Code
Description
License number
State
261QH0700X
Hearing and Speech Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1164854253
—
TX
Enumeration date
05/19/2025
Last updated
05/19/2025
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