Individual
ERICA WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
10551 BARKLEY ST STE 205, OVERLAND PARK, KS 66212-1812
(913) 213-0676
Mailing address
PO BOX 860063, SHAWNEE, KS 66286-0063
(913) 213-0676
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
09/19/2021
Last updated
09/19/2021
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