Individual
MRS. HOLLY WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.ED., CCC-SLP
Contact information
Practice address
4560 PRINCESS ANNE RD, VIRGINIA BEACH, VA 23462-7905
(757) 474-1289
Mailing address
1213 WORTHINGTON LN, VIRGINIA BEACH, VA 23464-5854
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
2202003129
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2202003129
VIRGINIA SLP LICENSE
VA
Enumeration date
07/02/2009
Last updated
07/02/2009
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