Individual
BREANNA WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
9130 METROPOLITAN AVE, FOREST HILLS, NY 11375-6671
(718) 286-4700
Mailing address
9130 METROPOLITAN AVE, FOREST HILLS, NY 11375-6671
(718) 286-4700
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
025278
NY
Other
Enumeration date
07/08/2014
Last updated
12/12/2016
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