Provider Demographics
NPI:1184058075
Name:WALLIS, KIMBERLY ELAINE DESSOFFY (MS)
Entity type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:ELAINE DESSOFFY
Last Name:WALLIS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 LOCUST ST STE 500
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44302-1877
Mailing Address - Country:US
Mailing Address - Phone:330-543-4197
Mailing Address - Fax:330-543-3677
Practice Address - Street 1:11100 EUCLID AVE
Practice Address - Street 2:1500 LAKESIDE
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106-1716
Practice Address - Country:US
Practice Address - Phone:216-844-3936
Practice Address - Fax:216-844-7497
Is Sole Proprietor?:No
Enumeration Date:2013-08-27
Last Update Date:2018-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No170300000XOther Service ProvidersGenetic Counselor, MS