Individual
STACIA WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2500 PACKARD ST, ANN ARBOR, MI 48104-6827
(586) 243-6466
Mailing address
526 W CENTRE AVE, PORTAGE, MI 49024-5306
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
02/26/2020
Last updated
07/21/2021
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