Individual
BRENDA WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
SLP
Contact information
Practice address
712 GIRARD BLVD NE, JEFFERSON MS, ALBUQUERQUE, NM 87106-2714
(505) 255-2334
Mailing address
712 GIRARD BLVD NE, JEFFERSON MS, ALBUQUERQUE, NM 87106-2714
(505) 255-2334
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
1338
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
J 5039
—
NM
Enumeration date
03/08/2007
Last updated
07/09/2007
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