Search › Illinois › 104100000X
Keith Wallace, L.C.S.W
NPI 1104971712 · on the registry since 2007 · sole proprietor
Practice
- Address
- Children'S Memorial Hospital
2300 Children'S Plaza, Box 10
Chicago, IL 60614 - Phone
- (773) 975-8604
- Clinicians at this address
- 10
Registry record
- Primary taxonomy
- 104100000X
104100000X
- Licence states on file
- IL
From the registry's licence fields, which are often incomplete.
- Sex
- Male
- Record last updated
- 2008-10-27
Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in Illinois