Individual
PATRICK JOHN WALLACE JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
13603 80TH CIR N, MAPLE GROVE, MN 55369-8961
(763) 274-3120
(763) 274-3121
Mailing address
909 GOULD AVE NE APT 329, COLUMBIA HEIGHTS, MN 55421-4718
(502) 287-9277
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
MN
Other
Enumeration date
12/30/2025
Last updated
12/30/2025
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