Debra Wallace's National Provider Identifier (NPI) Details
Debra Wallace, LMFT
NPI: 1598005019
Enumeration Date: 2013-02-20
Last updated: 2013-02-20
Sole Proprietor: YES
Status: active
Postal Address: 39469 N SHORE DR, SPRING GROVE, IL
Phone: 847-587-0475
Primary Practice Address: 27979 N CONVERSE RD, ISLAND LAKE, IL
Practice's phone: 847-850-9444