Individual
JENNIFER WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, CCC-SLP
Contact information
Practice address
1901 CENTURY BLVD NE STE 20, ATLANTA, GA 30345-3300
(404) 633-8911
(404) 633-6403
Mailing address
1901 CENTURY BLVD NE STE 20, ATLANTA, GA 30345-3300
(404) 633-8911
(404) 633-6403
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SLP006206
GA
Other
Enumeration date
06/27/2006
Last updated
07/29/2008
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