Individual
HOLLY WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LSW
Contact information
Practice address
1302 FRANKLIN AVE STE L500, NORMAL, IL 61761-3551
(309) 451-8888
Mailing address
2000 JACOBSSEN DR, NORMAL, IL 61761-6277
(309) 451-8888
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
150.114983
IL
Other
Enumeration date
12/03/2024
Last updated
12/03/2024
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