Individual
JENNIFER LEE WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSW, LSW
Contact information
Practice address
1 W MAIN ST, FLEETWOOD, PA 19522-1323
(610) 944-0445
(610) 944-8834
Mailing address
555 RIDGE RD, ORWIGSBURG, PA 17961-2217
(610) 960-7658
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
SW126587
PA
Other
Enumeration date
05/02/2014
Last updated
05/02/2014
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