Individual
PAIGE WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2055 CRAIGSHIRE RD, SAINT LOUIS, MO 63146-4036
(314) 275-0506
Mailing address
2626 WHIPPORWILL LN, GRANITE CITY, IL 62040-5251
(618) 219-0638
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
05/08/2023
Last updated
05/08/2023
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