Kenneth Ralph Wallace II, PSY.D.

NPI #1417135815 in Vienna, Ohio

Provider Information

NPI Number: 1417135815
Entity Type: Individual
Name: Kenneth Ralph Wallace II, PSY.D.
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Psychologist - Clinical
Credential: PSY.D.
Enumeration Date: Feb 7, 2008
Last Updated: Feb 7, 2008

Practice Location

Address: 3400 WARREN-SHARON ROAD
City: Vienna
State: Ohio
ZIP Code: 44473-9532
Phone: (330) 720-5768

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Psychologist - Clinical — Clinical	103TC0700X	Primary

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