Individual provider · Type 1 NPI
Tiffany Chantal Wallace
Developmental Therapist · Broadview, IL
Practice location
2312 S 23rd Ave
Broadview, IL 60155-3819
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Developmental Therapist Primary | 222Q00000X | None listed |
Developmental Therapist: A Developmental Therapist is a person qualified by completion of an approved program in Developmental Therapy and where applicable credentialed by the state and practicing within the scope of the credential, or credentialed by completion of education experiences as approved by the state and practicing within the scope of that credential or, where state credentialing does not exist, certified by the Board of the Deve…
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About NPI 1720991987
Tiffany Chantal Wallace's National Provider Identifier is 1720991987, issued on Sep 28, 2026. The primary taxonomy on file is Developmental Therapist (222Q00000X), and the practice location is in Broadview, IL. The record was last updated on Sep 28, 2026.