Wallace, Brenda

Wallace, Brenda is an sole proprietor health care provider with primary practice located at 712 Girard Blvd Ne Jefferson Ms, Albuquerque NM 87106-2714. She recently has only one registered license in Speech, Language and Hearing Service Providers / Speech-Language Pathologist, which is considered as her primary health care specialty. Wallace, Brenda can be contacted via phone (505) 255-2334.

Contact Information

Primary practice address
712 Girard Blvd Ne Jefferson Ms Albuquerque NM 87106-2714
Phone: (505) 255-2334
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Speech, Language and Hearing Service Providers / Speech-Language Pathologist 235Z00000X 1338 New Mexico

Profile Details

NPI number 1457482903
LBN Legal business name Wallace, Brenda
Credentials SLP
Entity Individual
Sole proprietor 1 Yes
Enumeration date Mar 8th, 2007
Last updated Jul 9th, 2007 - about 19 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1457482903 NPPES
New Mexico MEDICAID J 5039

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