Individual
MEGAN A WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BA
Contact information
Practice address
7330 W LAYTON AVE, MILWAUKEE, WI 53220-3849
(414) 877-1071
Mailing address
7330 W LAYTON AVE, MILWAUKEE, WI 53220-3849
(414) 877-1071
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
15367-131
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
39179700
—
WI
Enumeration date
09/11/2007
Last updated
12/16/2019
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