Individual
MARY TERESE WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
939 CAROLINE ST, PORT ANGELES, WA 98362-3997
(360) 417-7125
(360) 417-7188
Mailing address
700 BROADWAY, SEATTLE, WA 98122-4302
(206) 720-3734
(206) 292-2163
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
DI 60685427
WA
Other
Enumeration date
10/27/2016
Last updated
04/11/2023
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