Individual
LEONA C WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1215 INDEPENDENCE BLVD, ZACHARY, LA 70791-7390
(225) 286-1547
Mailing address
996 ROYAL MARCO WAY, MARCO ISLAND, FL 34145-1829
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
12065646
LA
Other
Enumeration date
08/12/2024
Last updated
08/12/2024
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