Individual
DR. DANIEL WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DSW
Contact information
Practice address
22997 KRISTINE LN, RICHTON PARK, IL 60471-1273
(708) 925-7022
Mailing address
22997 KRISTINE LN, RICHTON PARK, IL 60471-1273
(708) 925-7022
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
150.106556
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
W42016193278
—
IL
Enumeration date
08/23/2018
Last updated
01/30/2024
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