Individual
MR. BENNETT ALLAN WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.S.S.W
Contact information
Practice address
164 E ASHLAND AVE, LOUISVILLE, KY 40214-1908
(502) 693-2606
Mailing address
164 E ASHLAND AVE, LOUISVILLE, KY 40214-1908
(502) 693-2606
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
3772
KY
Other
Enumeration date
11/17/2011
Last updated
11/17/2011
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