DR. Susan 'suzi' Wallace, PHD, PT, LPC

NPI #1124215256 in Fort Smith, Arkansas

Provider Information

NPI Number: 1124215256
Entity Type: Individual
Name: DR. Susan 'suzi' Wallace, PHD, PT, LPC
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Psychologist - Clinical
Credential: PHD, PT, LPC
Enumeration Date: Oct 3, 2007
Last Updated: Aug 30, 2018

Practice Location

Address: 5111 ROGERS AVENUE, SUITE 533
Address 2: CENTRAL MALL PLAZA SUITES #533
City: Fort Smith
State: Arkansas
ZIP Code: 72903
Phone: (479) 651-7413

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Counselor - Professional — Professional	101YP2500X
Physical Therapist	225100000X
Psychologist - Clinical — Clinical	103TC0700X	Primary

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