Individual
MALLORY WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
8725 BROOKS CREEK DR APT 2125, CINCINNATI, OH 45249-2089
(424) 333-5672
Mailing address
8725 BROOKS CREEK DR APT 2125, CINCINNATI, OH 45249-2089
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
—
—
Other
Enumeration date
03/28/2023
Last updated
03/28/2023
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