Provider Demographics
NPI:1912033036
Name:WALLACE, ANN SHIRLEY
Entity Type:Individual
Prefix:MS
First Name:ANN
Middle Name:SHIRLEY
Last Name:WALLACE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1450 S ASH ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80222-3629
Mailing Address - Country:US
Mailing Address - Phone:303-759-2673
Mailing Address - Fax:
Practice Address - Street 1:1450 S ASH ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80222-3629
Practice Address - Country:US
Practice Address - Phone:303-759-2673
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health