NPI 1083446405

Nicole L Wallace, IS

Practitioner Assistant Behavior Analyst Idaho Falls, ID

Practice location

Address: 2185 Koro Ave, Idaho Falls, ID 83404-6226
Phone: (520) 233-3382

Registered specialties

Assistant Behavior Analyst Primary

Behavioral Health & Social Service Providers Taxonomy 106E00000X

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Registry record

NPI: 1083446405
Entity type: Individual
Sex (as registered): Female
NPI issued: 14 Aug 2024
Record last updated: 14 Aug 2024

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.