Individual
DALENE WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
37 BIG CHIEF DR, BOURBONNAIS, IL 60914-9510
(815) 981-1225
Mailing address
37 BIG CHIEF DR, BOURBONNAIS, IL 60914-9510
(815) 981-1225
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-26-511385
IL
Other
Enumeration date
05/14/2026
Last updated
05/14/2026
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