Individual
MARGARET SUSAN WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
6315 MUTUAL DR, SUITE B, FORT WAYNE, IN 46825-4238
(260) 409-8188
(866) 742-8426
Mailing address
10214 CHESTNUT PLAZA DR, #130, FORT WAYNE, IN 46814-8970
(260) 409-8188
(866) 742-8426
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
39002298A
IN
Other
Enumeration date
08/31/2012
Last updated
08/31/2012
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