Individual
KATHLEEN WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
11845 STERLING HWY, NINILCHIK, AK 99639-9769
(907) 567-3990
(907) 567-3990
Mailing address
11845 STERLING HWY, NINILCHIK, AK 99639-9769
(907) 567-3990
(907) 567-3990
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
AK
Other
Enumeration date
10/29/2014
Last updated
10/29/2014
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