Individual
JILL WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2600 N MAYFAIR RD STE 400, WAUWATOSA, WI 53226-1306
(414) 933-9390
Mailing address
2600 N MAYFAIR RD STE 400, WAUWATOSA, WI 53226-1306
(414) 933-9390
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YP2500X
Professional Counselor
Primary
—
—
102X00000X
Poetry Therapist
—
—
Other
Enumeration date
03/08/2022
Last updated
03/08/2022
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