Madison Wallace, MHP

NPI #1003622937 in Dixon, Illinois

Provider Information

NPI Number: 1003622937
Entity Type: Individual
Name: Madison Wallace, MHP
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Counselor - Mental Health
Credential: MHP
Enumeration Date: Dec 5, 2024
Last Updated: Dec 5, 2024

Practice Location

Address: 325 ILLINOIS RT 2
City: Dixon
State: Illinois
ZIP Code: 61021-9118
Phone: (815) 284-6611

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Counselor - Mental Health — Mental Health	101YM0800X	Primary

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