Individual
MRS. JANICE LEIGH WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA, CCC-SLP/L
Contact information
Practice address
74 OLD HOME RD, EDDYVILLE, IL 62928-9734
(618) 672-4300
Mailing address
74 OLD HOME RD, EDDYVILLE, IL 62928-9734
(618) 672-4300
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
146008090
IL
Other
Enumeration date
06/25/2012
Last updated
06/25/2012
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