Provider Demographics
NPI:1710368642
Name:WALLACE, JUDY C (MS,SPED,LIT)
Entity Type:Individual
Prefix:
First Name:JUDY
Middle Name:C
Last Name:WALLACE
Suffix:
Gender:F
Credentials:MS,SPED,LIT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:535 LEIN RD
Mailing Address - Street 2:
Mailing Address - City:WEST SENECA
Mailing Address - State:NY
Mailing Address - Zip Code:14224-2443
Mailing Address - Country:US
Mailing Address - Phone:716-674-3062
Mailing Address - Fax:
Practice Address - Street 1:4242 RIDGE LEA RD
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14226-1051
Practice Address - Country:US
Practice Address - Phone:716-819-2400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-16
Last Update Date:2016-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist