Individual
MS. JAN ELLEN WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
140 N TUCSON BLVD, TUCSON, AZ 85716-4740
(520) 396-1021
(520) 881-1648
Mailing address
140 N TUCSON BLVD, TUCSON, AZ 85716-4740
(520) 396-1021
(520) 881-1648
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LCSW-1647
AZ
Other
Enumeration date
08/19/2013
Last updated
08/19/2013
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