Individual
MRS. INGRID WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
L.P.C., C.R.C.
Contact information
Practice address
2525 N MAYFAIR RD, SUITE 200, WAUWATOSA, WI 53226-1403
(414) 476-8183
(414) 476-8465
Mailing address
2525 N MAYFAIR RD, SUITE 200, WAUWATOSA, WI 53226-1403
(414) 476-8183
(414) 476-8465
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
3065-125
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
21280000
—
WI
Enumeration date
08/31/2006
Last updated
07/09/2007
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