Individual
BOBBY WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
B.A.
Contact information
Practice address
3221 BEHRMAN PL, NEW ORLEANS, LA 70114-8200
(504) 263-2800
Mailing address
3221 BEHRMAN PL, NEW ORLEANS, LA 70114-8200
(504) 263-2800
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1346524378
—
LA
Enumeration date
02/22/2017
Last updated
02/22/2017
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