Individual provider · Type 1 NPI
Vincent Wallace, MA
Substance Use Disorder Rehabilitation Clinic/Center · Chicago, IL
NPI number
1144852260
Active
Practice location
226 W Ontario St
Chicago, IL 60654-3619
Fax (312) 533-2842
Mailing address
19050 Maple Ave
Country Club Hills, IL 60478-5737
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Substance Use Disorder Rehabilitation Clinic/Center Primary | 261QR0405X | None listed |
Substance Use Disorder Rehabilitation Clinic/Center: Definition to come...
2 other providers at this address
Other substance use disorder rehabilitation clinic/center providers in Chicago
- Shekena Ann MillerSubstance Use Disorder Rehabilitation Clinic/Center Chicago, IL NPI 1306477989
- Sixto Garcia, CADCSubstance Use Disorder Rehabilitation Clinic/Center Chicago, IL NPI 1437679255
- Andre D. Newsome, MS, MS, MHS, CADCSubstance Use Disorder Rehabilitation Clinic/Center Chicago, IL NPI 1568982809
About NPI 1144852260
Vincent Wallace, MA's National Provider Identifier is 1144852260, issued on Feb 6, 2020. The primary taxonomy on file is Substance Use Disorder Rehabilitation Clinic/Center (261QR0405X), and the practice location is in Chicago, IL. The record was last updated on Feb 6, 2020.