MR. John Jason Wallace, LCSW
NPI #1063652097 in Wilkes Barre, Pennsylvania
Provider Information
- NPI Number
- 1063652097
- Entity Type
- Individual
- Name
- MR. John Jason Wallace, LCSW
- Gender
- Not Specified
- Sole Proprietor
- No
- Primary Specialty
- Social Worker - Clinical
- Credential
- LCSW
- Enumeration Date
- Mar 4, 2009
- Last Updated
- Mar 4, 2009
Practice Location
- Address
- 1111 E END BLVD
- City
- Wilkes Barre
- State
- Pennsylvania
- ZIP Code
- 18711-0030
- Phone
- (570) 824-3521
Specialties & Taxonomy Codes
| Specialty |
|---|
| Social Worker - Clinical — Clinical |
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