Individual
KENNETH RALPH WALLACE II
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PSY.D.
Contact information
Practice address
3400 WARREN-SHARON ROAD, VIENNA, OH 44473-9532
(330) 720-5768
Mailing address
3400 WARREN-SHARON ROAD, VIENNA, OH 44473-9532
(330) 720-5768
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
4838
OH
103TC0700X
Clinical Psychologist
PS015513
PA
Other
Enumeration date
02/07/2008
Last updated
02/07/2008
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