Individual
JENNIFER RENEA WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
B.A
Contact information
Practice address
3802 W UNIVERSITY BLVD APT 8104, DURANT, OK 74701-3047
(580) 465-5961
Mailing address
3802 W UNIVERSITY BLVD APT 8104, DURANT, OK 74701-3047
(580) 465-5961
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
OK
Other
Enumeration date
04/24/2010
Last updated
04/24/2010
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