Individual
DIANNA LYNN WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
7010 E BOGARD RD, WASILLA, AK 99654-4711
(907) 373-4732
Mailing address
PO BOX 876741, WASILLA, AK 99687-6741
(907) 373-4732
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
AK
Other
Enumeration date
09/03/2025
Last updated
09/03/2025
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