Individual
ASIA GWEN-NAE WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
416 W 15TH ST STE 600, EDMOND, OK 73013-3672
(572) 910-4971
Mailing address
416 W 15TH ST STE 600, EDMOND, OK 73013-3672
(572) 910-4971
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
OK
Other
Enumeration date
05/11/2026
Last updated
05/11/2026
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