Individual
MEGAN M WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AU.D.
Contact information
Practice address
2502 E EMPIRE ST, BLOOMINGTON, IL 61704-3738
(309) 663-4368
(095) 245-3573
Mailing address
101 W UNIVERSITY AVE, CHAMPAIGN, IL 61820-3909
(815) 971-2000
(815) 971-9729
Taxonomy
Speciality
Code
Description
License number
State
231H00000X
Audiologist
Primary
147001429
IL
Other
Enumeration date
08/02/2012
Last updated
01/05/2022
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