Data from the NPPES registry. May not reflect recent changes — verify at nppes.cms.hhs.gov.
KENNETH RALPH WALLACE II, PSY.D.
Active Sole ProprietorKENNETH RALPH WALLACE II, PSY.D. is a Clinical Psychologist healthcare provider located in VIENNA, Ohio. NPI 1417135815 is currently active in the NPPES registry. Verify at CMS.
Clinical Psychologist · VIENNA, OH
Registration Details
- NPI Number
- 1417135815
- Provider Type
- Individual
- Gender
- Male
- NPI Issued
- Feb 7, 2008 (18.508006068673 yrs)
- Last Updated
- Feb 7, 2008
- Licenses
-
PS015513 (PA)4838 (OH)
- Sole Proprietor
- Yes
Practice Information
- Address
-
3400 WARREN-SHARON ROADVIENNA, OH, 444739532Browse OH providers · Browse ZIP 44473
- Phone
- 3307205768
- Primary Specialty
-
Clinical Psychologist
103TC0700X
- Additional Specialty
- Clinical Psychologist
Data sourced from the NPPES National Provider Identifier registry. This information is for informational purposes only and is not a substitute for verifying credentials with the appropriate licensing authority. For official verification, use the NPPES NPI Registry or the relevant state medical board.