Individual
MRS. SUZANNE MARIE WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M. ED
Contact information
Practice address
180 FAIRFIELD AVE, BRIDGEPORT, CT 06604-4252
(203) 394-6529
Mailing address
239 EDWARD ST, FAIRFIELD, CT 06824-6702
(203) 255-5882
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
12/14/2006
Last updated
07/08/2007
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