Individual
STEFANIE WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
7954 UNIVERSITY AVE NE, FRIDLEY, MN 55432-1860
(763) 780-3036
Mailing address
7954 UNIVERSITY AVE NE, FRIDLEY, MN 55432-1860
(763) 780-3036
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
3103
MN
Other
Enumeration date
06/08/2015
Last updated
02/22/2017
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