Individual
ALEXANDER JEREMY WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MSW
Contact information
Practice address
1708 BANYAN CT, CERES, CA 95307-1907
(209) 531-2088
Mailing address
701 N TUXEDO AVE, STOCKTON, CA 95204-5129
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
ASW136556
CA
Other
Enumeration date
02/13/2026
Last updated
02/13/2026
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