Individual
MR. DALE A WALLENTINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
BS PSY
Contact information
Practice address
1407 SAINT ANDREW ST STE 100, LA CROSSE, WI 54603-2378
(608) 785-6304
Mailing address
2801 27TH ST S, LA CROSSE, WI 54601-7653
(608) 790-4802
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
3139-120
WI
Other
Enumeration date
03/28/2007
Last updated
07/08/2007
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