Individual
ERICKA WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
PO BOX 665, MATTESON, IL 60443-0665
(312) 613-3335
Mailing address
3935 W 64TH PL, CHICAGO, IL 60629-4714
(312) 613-3335
Taxonomy
Speciality
Code
Description
License number
State
133N00000X
Nutritionist
Primary
18343
IL
Other
Enumeration date
10/02/2025
Last updated
10/02/2025
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