Individual
COURTNEY WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
APSW
Contact information
Practice address
620 S 76TH ST, MILWAUKEE, WI 53214-1599
(414) 292-4242
(414) 453-2538
Mailing address
620 S 76TH ST, MILWAUKEE, WI 53214-1599
(414) 292-4242
(414) 453-2538
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
134408
WI
Other
Enumeration date
10/29/2024
Last updated
03/03/2025
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