Jessica Wallace's National Provider Identifier (NPI) Details
Jessica Wallace, LPC
NPI: 1932855871
Enumeration Date: 2022-03-01
Last updated: 2022-03-05
Sole Proprietor: YES
Status: active
Postal Address: S5564 COUNTY RD S, VIOLA, WI
Phone: 920-309-3040
Primary Practice Address: 414 S EAST AVE, VIROQUA, WI
Practice's phone: 608-638-3332