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Individual

MRS. SHAWNESHA WALLACE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
BCBA, LBA

Contact information

Practice address
1200 N EL DORADO PL STE G700, TUCSON, AZ 85715-4637
(520) 526-0050
Mailing address
10214 E CALLE ESTRELLA POLAR, TUCSON, AZ 85747-5169
(520) 230-6965

Taxonomy

Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
BEH-000379
AZ

Other

Enumeration date
02/09/2018
Last updated
12/20/2018
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