Audrey Lucille Wallace
NPI #1285460097 in Jerseyville, Illinois
Provider Information
- NPI Number
- 1285460097
- Entity Type
- Individual
- Name
- Audrey Lucille Wallace
- Gender
- Not Specified
- Sole Proprietor
- No
- Primary Specialty
- Behavior Technician
- Enumeration Date
- Sep 9, 2024
- Last Updated
- Sep 9, 2024
Practice Location
- Address
- 26034 CEMETERY RD
- City
- Jerseyville
- State
- Illinois
- ZIP Code
- 62052-6385
- Phone
- (618) 535-2112
Specialties & Taxonomy Codes
| Specialty |
|---|
| Behavior Technician |
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