Individual
COLLEEN BRIDGET WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.S, CCC-SLP
Contact information
Practice address
4050 LAKE OTIS PKWY, SUITE 201, ANCHORAGE, AK 99508-5223
(505) 489-7764
Mailing address
2201 ROMIG PL, # 406, ANCHORAGE, AK 99503-1680
(505) 489-7764
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
489
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1031087
—
AK
Enumeration date
03/02/2015
Last updated
04/06/2022
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