Individual provider · Type 1 NPI
Susan R. Wallace
Mental Health Counselor · Chicago, IL
NPI number
1043958176
Active
Practice location
2715 N Central Ave
Chicago, IL 60639-1351
Mailing address
86 E 13th St
Chicago Heights, IL 60411-2761
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Mental Health Counselor Primary | 101YM0800X | None listed |
Mental Health Counselor: Definition to come...
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About NPI 1043958176
Susan R. Wallace's National Provider Identifier is 1043958176, issued on May 27, 2022. The primary taxonomy on file is Mental Health Counselor (101YM0800X), and the practice location is in Chicago, IL. The record was last updated on May 27, 2022.