Wallace, Jill

Wallace, Jill is an sole proprietor health care provider with primary practice located at 2600 N Mayfair Rd Ste 400 , Wauwatosa WI 53226-1306. She recently has 3 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder), Behavioral Health & Social Service Providers / Poetry Therapist, Behavioral Health & Social Service Providers / Professional. Behavioral Health & Social Service Providers / Professional is her primary health care specialty. Wallace, Jill can be contacted via phone (414) 933-9390.

Contact Information

Primary practice address
2600 N Mayfair Rd Ste 400 Wauwatosa WI 53226-1306
Phone: (414) 933-9390
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) 101YA0400X
Behavioral Health & Social Service Providers / Poetry Therapist 102X00000X
Behavioral Health & Social Service Providers / Professional 101YP2500X

Profile Details

NPI number 1871240978
LBN Legal business name Wallace, Jill
Credentials
Entity Individual
Sole proprietor 1 Yes
Enumeration date Mar 8th, 2022
Last updated Mar 8th, 2022 - about 2 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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