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Individual

APRIL D WALLACE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PSYD

Contact information

Practice address
235 E STATE ST, SAINT CROIX FALLS, WI 54024-4117
(715) 483-3221
(715) 483-0507
Mailing address
235 E STATE ST, SAINT CROIX FALLS, WI 54024-4117
(715) 483-3221
(715) 483-0507

Taxonomy

Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
2189-057
WI
103T00000X
Psychologist
LP2603
MN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0413704
MEDICA
01
2189057
WI STATE LICENSE
WI
01
27G52WA
BLUE CROSS FACILITY
MN
05
39129500
WI
01
47386934001
WI BLUE CROSS
WI
01
474668299
CHAMPUS TRICARE
05
596713900
MN
01
64Q42WA
BLUE CROSS PRO FEE
MN
01
680012001
RAILROAD MEDICARE
01
HP27845
HEALTHPARTNERS
01
LP2603
MN STATE LICENSE
MN
01
NA9031022307
PREFERREDONE
Enumeration date
09/21/2006
Last updated
02/02/2021
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