Individual
MARY WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1605 E ASH ST, CANTON, IL 61520-1510
(309) 647-6951
Mailing address
1605 E ASH ST, CANTON, IL 61520-1510
(309) 647-6951
Taxonomy
Speciality
Code
Description
License number
State
103TS0200X
School Psychologist
Primary
—
—
Other
Enumeration date
08/25/2017
Last updated
07/21/2022
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