Wallace, Johnna
Wallace, Johnna is an individual health care provider with primary practice located at 11500 N Portland Ave , Oklahoma City OK 73120. She recently has only one registered license in Speech, Language and Hearing Service Providers / Audiologist, which is considered as her primary health care specialty. Wallace, Johnna can be contacted via phone (405) 548-4300.Contact Information
Primary practice address
11500 N Portland Ave
Oklahoma City OK 73120
Phone: (405) 548-4300
Fax: (405) 548-4350
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Speech, Language and Hearing Service Providers / Audiologist | 231H00000X | 4140 | Oklahoma |
Profile Details
| NPI number | 1740610005 |
|---|---|
| LBN Legal business name | Wallace, Johnna |
| Credentials | AUD |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Nov 22nd, 2013 |
| Last updated | May 29th, 2019 - about 7 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 | 1740610005 | NPPES |
| Oklahoma | MEDICAID | 200100230A |
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