Individual
BRIEANNA WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
10975 SW PACINI WAY, PORT ST LUCIE, FL 34987-6306
(954) 319-9976
Mailing address
10975 SW PACINI WAY, PORT ST LUCIE, FL 34987-6306
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
—
—
Other
Enumeration date
04/14/2022
Last updated
04/14/2022
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