Kanisha Wallace
Kanisha Wallace is a Social Worker in Champaign, Illinois. Practices as a sole proprietor. Registered with an NPI since 2012.
- In the registry since
- 2012
Practice location Address checks out
401 W Springfield AveChampaign, IL 61820-4716
Phone: (217) 398-8464
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Pin is approximate — placed at the ZIP-code centre, not the exact door.
Specialties & licences
| Social Worker (primary) | Taxonomy 104100000X |
|---|
Record details
| NPI number | 1740541341 |
|---|---|
| Entity type | Individual (Type 1) |
| Gender | Female |
| Sole proprietor | Yes |
| NPI enumerated | May 31, 2012 |
| Last updated in NPPES | May 31, 2012 |
| Mailing address | 401 W Springfield Ave, Champaign, IL 61820-4716 |
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