Individual
MIKELIA WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MT-BC
Contact information
Practice address
12608 SE ALDER ST APT 60, PORTLAND, OR 97233-1688
(352) 303-5352
Mailing address
12608 SE ALDER ST APT 60, PORTLAND, OR 97233-1688
(352) 303-5352
Taxonomy
Speciality
Code
Description
License number
State
225A00000X
Music Therapist
Primary
16398
—
Other
Enumeration date
01/12/2023
Last updated
01/12/2023
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