Individual
MS. MARY CAROLINE WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.A.
Contact information
Practice address
5 5TH ST SE, WASHINGTON, DC 20003-1119
(434) 242-2039
Mailing address
5 5TH ST SE, WASHINGTON, DC 20003-1119
(434) 242-2039
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
2202005615
VA
Other
Enumeration date
09/23/2008
Last updated
09/23/2008
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