Kathleen Peterson Wallace MA, CCC-SLP

NPI 1154507820 - Speech-Language Pathologist - 235Z00000X

NPI Details
NPI 1154507820
Gender Female
Enumeration Date 01/12/2008
Last Updated 01/12/2008
Entity Type Individual
Active Over 8 years ago
Practice Location
425 MCLILLIE LN
COVINGTON TN, 38019-6413, US
Phone (901) 476-7918
Fax
Business Location
425 MCLILLIE LN
COVINGTON TN, 38019-6413, US
Phone (901) 476-7918
Fax
Toxanomy
Taxonomy Code 235Z00000X
License State Tennessee
License Number SP 0000000512
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According to our database, Mrs. Kathleen Peterson Wallace MA, CCC-SLP NPI is 1154507820, taxonomy code is 235Z00000X and license number is SP 0000000512, license state is located at Tennessee. Kathleen Peterson Wallace MA, CCC-SLP physically located at 425 Mclillie Ln, Covington TN, 38019-6413. NPI Number Kathleen Peterson Wallace MA, CCC-SLP has the Individual type.

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1154507820 NPI number is provided on an as is basis without warranty of any kind. 1154507820 is maintained by the National Plan & Provider Enumeration System. The contents of Kathleen Peterson Wallace MA, CCC-SLP are for informational purposes only.