Individual
MEGAN WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMHC
Contact information
Practice address
110 E MAIN ST, OTTUMWA, IA 52501-2910
(641) 682-8772
(641) 682-1924
Mailing address
110 E MAIN ST, OTTUMWA, IA 52501-2910
(641) 682-8772
(641) 682-1924
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
072445
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1659353670
BLUE CROSS BLUE SHIELD OF IOWA
IA
05
—
1659353670
—
IA
Enumeration date
09/09/2014
Last updated
09/09/2014
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