Individual
JEANNE WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3491 STATE ROUTE 108, WAUSEON, OH 43567-9410
(419) 335-5533
Mailing address
311 E MARKET ST, THIRD FLOOR, LIMA, OH 45801-4535
(419) 222-4474
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Enumeration date
12/21/2016
Last updated
12/21/2016
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