Individual
MICHAEL DAVID WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
10850 W PARK PL, SUITE # 100, MILWAUKEE, WI 53224-3606
(262) 542-3255
(414) 359-1021
Mailing address
3022 N 81ST ST, MILWAUKEE, WI 53222-4810
(414) 449-1491
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
2578-123
WI
Other
Enumeration date
01/02/2007
Last updated
07/08/2007
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