Individual
ROBIN SUE WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
SLP
Contact information
Practice address
17674 W HIGHWAY 32, LICKING, MO 65542-9018
(573) 201-8534
Mailing address
17674 W HIGHWAY 32, LICKING, MO 65542-9018
(573) 201-8534
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
2021034135
MO
Other
Enumeration date
08/24/2021
Last updated
08/24/2021
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