Wallace, Ingrid
Wallace, Ingrid is an individual health care provider with primary practice located at 2525 N Mayfair Rd Suite 200, Wauwatosa WI 53226-1403. She recently has only one registered license in Behavioral Health & Social Service Providers / Professional, which is considered as her primary health care specialty. Wallace, Ingrid can be contacted via phone (414) 476-8183.Contact Information
Primary practice address
2525 N Mayfair Rd Suite 200
Wauwatosa WI 53226-1403
Phone: (414) 476-8183
Fax: (414) 476-8465
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Professional | 101YP2500X | 3065-125 | Wisconsin |
Profile Details
| NPI number | 1497866370 |
|---|---|
| LBN Legal business name | Wallace, Ingrid |
| Credentials | L.P.C., C.R.C. |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Aug 31st, 2006 |
| 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1497866370 | NPPES |
| Wisconsin | MEDICAID | 21280000 |
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