Individual
JOHNNA WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AUD
Contact information
Practice address
11500 N PORTLAND AVE, OKLAHOMA CITY, OK 73120
(405) 548-4300
(405) 548-4350
Mailing address
11500 N PORTLAND AVE, OKLAHOMA CITY, OK 73120-4625
(405) 548-4300
(405) 548-4350
Taxonomy
Speciality
Code
Description
License number
State
231H00000X
Audiologist
Primary
4140
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200100230A
—
OK
Enumeration date
11/22/2013
Last updated
02/28/2025
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