MR. Randall Dean Wallace, M.S.

NPI #1689768707 in Cambridge, Minnesota

Provider Information

NPI Number: 1689768707
Entity Type: Individual
Name: MR. Randall Dean Wallace, M.S.
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Psychologist
Credential: M.S.
Enumeration Date: Oct 3, 2006
Last Updated: Jul 8, 2007

Practice Location

Address: 133 2ND AVE SW
City: Cambridge
State: Minnesota
ZIP Code: 55008-1552
Phone: (763) 689-9407

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Psychologist	103T00000X	Primary

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