Individual
DYLAN WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW, QCSW
Contact information
Practice address
34 MAIN STREET EXT STE 104, PLYMOUTH, MA 02360-3375
(801) 655-5450
(385) 225-9327
Mailing address
1469 N 1200 W, OREM, UT 84057-2449
(801) 655-5450
(385) 225-9327
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
11338410-3501
UT
1041C0700X
Clinical Social Worker
3381901
ID
1041C0700X
Clinical Social Worker
LCSW-22060
AZ
1041C0700X
Clinical Social Worker
Primary
LICSW126861
MA
1041C0700X
Clinical Social Worker
LW61224850
WA
1041C0700X
Clinical Social Worker
SW15210
FL
1041C0700X
Clinical Social Worker
SWI.LW.61224850
WA
Other
Enumeration date
05/03/2019
Last updated
04/02/2026
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