Individual
DAVINA WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.S.,CCC-SLP
Contact information
Practice address
12768 WOOD TRAIL BLVD, TAMPA, FL 33625-5905
(813) 215-6275
(866) 636-0443
Mailing address
13014 N DALE MABRY HWY STE 659, TAMPA, FL 33618-2808
(813) 215-6275
(813) 852-6373
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
—
—
235Z00000X
Speech-Language Pathologist
Primary
SA3018
FL
Other
Enumeration date
12/03/2012
Last updated
12/15/2020
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