Individual
MS. GWENDOLYN DEANE WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS-CF,SLP
Contact information
Practice address
4805 W 4TH ST, HATTIESBURG, MS 39402-1019
(601) 270-6968
(601) 758-0982
Mailing address
4805 W 4TH ST, HATTIESBURG, MS 39402-1019
(607) 270-6968
(601) 758-0982
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
S-4735
MS
Other
Enumeration date
01/28/2021
Last updated
01/28/2021
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