Most Relevant Information
Provider Data
| NPI Number: | 1003064213 |
| Provider Name: | JENNIFER WALLACE LCSW |
| Entity Type: | Individual |
| Taxonomy Code: | 1041C0700X |
| Specialty: | Social Worker |
| License Number: | CSW.00001141 |
Most Important Dates
| Enumeration Date: | 08/29/2008 |
| Last Updated: | 09/09/2014 |
Provider Practice Location
1300 N 17TH AVE
GREELEY
CO
806319584
Practice Location Phone/Fax
| Phone: | 9703472120 |
| Fax: |
Provider Mailing Location
1300 N 17TH AVE
GREELEY
CO
806319584
Provider Mailing Phone/Fax
| Phone: | 9703472120 |
| Fax: |