Individual
DANA WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3737 RED BLUFF RD, PASADENA, TX 77503-3307
(713) 740-5000
Mailing address
3737 RED BLUFF RD, PASADENA, TX 77503-3307
(713) 740-5000
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
39456
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
LSW#39456
LSW STATE LICENSE
TX
Enumeration date
03/14/2007
Last updated
07/09/2007
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