Individual
PATRICIA J WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1 CHESTERFIELD MALL, CHESTERFIELD, MO 63017-4807
(636) 536-4660
(636) 532-4667
Mailing address
1 CHESTERFIELD MALL, CHESTERFIELD, MO 63017-4807
(636) 536-4660
(636) 532-4667
Taxonomy
Speciality
Code
Description
License number
State
237700000X
Hearing Instrument Specialist
Primary
2013004502
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2013004502
HEARING AID DISPENSER LICENSE
MO
Enumeration date
09/20/2013
Last updated
09/20/2013
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