Individual
ELLIE N WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.S., SLP
Contact information
Practice address
801 JEFFERSON AVE, CHARLESTON, IL 61920-1527
(217) 639-7000
Mailing address
331 W FRYER AVE, CHARLESTON, IL 61920-1847
(217) 932-3873
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
242.007619
IL
Other
Enumeration date
05/20/2024
Last updated
05/20/2024
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