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NPI Code Detail

MEDICARE: EMILY MARISSA WALLACE

MEDICARE: EMILY MARISSA WALLACE
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1235Z00000XSpeech-Language PathologistCF791OK

General Provider Information

NPI Number : 1003700444
Entity Type Code : Individual
Provider Name (Legal Business Name) : EMILY MARISSA WALLACE
Provider Business Mailing Address
First Line : 6846 S CANTON AVE
Second Line :
City : TULSA
State : OK
Zip : 74136-3412
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 6846 S CANTON AVE
Second Line :
City : TULSA
State : OK
Zip : 74136-3412
Country : US
Telephone Number : 918-806-0106
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/09/2025
Last Update Date : 06/02/2026

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Directions to “ EMILY MARISSA WALLACE ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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