Individual
EVAN C WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMSW
Contact information
Practice address
154 FORREST DR, HANNIBAL, MO 63401-5511
(573) 221-2120
(573) 221-4380
Mailing address
154 FORREST DR, HANNIBAL, MO 63401-5511
(573) 221-2120
(573) 221-4380
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
2024022765
MO
Other
Enumeration date
07/02/2024
Last updated
07/02/2024
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