Individual
MRS. TINA LOUISE WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ALC
Contact information
Practice address
1000 HIGHWAY 78 W, JASPER, AL 35501-3655
(205) 512-1260
(844) 269-8087
Mailing address
1000 HIGHWAY 78 W, JASPER, AL 35501-3655
(205) 512-1260
(844) 269-8087
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
3541
AL
Other
Enumeration date
10/20/2021
Last updated
10/20/2021
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