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Individual
SADIE NOELLE WALLACE
Active
Individual
SADIE NOELLE WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
L-494
LA
106E00000X
Assistant Behavior Analyst
—
NULL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1-20-43732
NATIONAL BOARD ANALYST BOARD CERTIFICATION
—
01
—
L-494
STATE LICENSE FOR BEHAVIOR ANALYST
LA
Enumeration date
04/30/2018
Last updated
03/29/2021
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