Individual
ELIZABETH WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
195 W SCHROCK RD, WESTERVILLE, OH 43081-2890
(614) 355-7570
(614) 355-7580
Mailing address
700 CHILDRENS DR, COLUMBUS, OH 43205-2664
(614) 722-2000
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
12/06/2017
Last updated
06/21/2022
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