Keith V. Wallace L.C.S.W.

NPI 1104971712 - Social Worker - 104100000X

NPI Details
NPI 1104971712
Gender Male
Enumeration Date 01/24/2007
Last Updated 10/27/2008
Entity Type Individual
Active Over 9 years ago
Practice Location
CHILDREN'S MEMORIAL HOSPITAL
2300 CHILDREN'S PLAZA, BOX 10
CHICAGO IL, 60614, US
Phone (773) 975-8604
Fax
Business Location
CHILDREN'S MEMORIAL HOSPITAL
2300 CHILDREN'S PLAZA, BOX 10
CHICAGO IL, 60614, US
Phone (773) 975-8604
Fax
Toxanomy
Taxonomy Code 104100000X
License State Illinois
License Number 149-012034
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According to our database, Mr. Keith V. Wallace L.C.S.W. NPI is 1104971712, taxonomy code is 104100000X and license number is 149-012034, license state is located at Illinois. Keith V. Wallace L.C.S.W. physically located at Children's Memorial Hospital, Chicago IL, 60614. NPI Number Keith V. Wallace L.C.S.W. has the Individual type.

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1104971712 NPI number is provided on an as is basis without warranty of any kind. 1104971712 is maintained by the National Plan & Provider Enumeration System. The contents of Keith V. Wallace L.C.S.W. are for informational purposes only.