| Lisa Wallace | |
|
20200 Governors Dr 107 Olympia Fields IL 60461-1032 | |
| (708) 462-4235 | |
| Not Available |
| Full Name | Lisa Wallace |
|---|---|
| Speciality | Counselor - Mental Health |
| Location | 20200 Governors Dr, Olympia Fields, Illinois |
| Authorized Official Name and Position | Lisa Wallace (PROVIDER) |
| Authorized Official Contact | 7089060205 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Lisa Wallace 1835 W 34th St Steger IL 60475-1499 Ph: (708) 906-0205 | Lisa Wallace 20200 Governors Dr 107 Olympia Fields IL 60461-1032 Ph: (708) 462-4235 |
| NPI Number | 1427463405 |
|---|---|
| Provider Enumeration Date | 06/27/2014 |
| Last Update Date | 06/27/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1427463405 | NPI | - | NPPES |
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