Individual
ELOISE F WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
15600 19 MILE RD, CLINTON TOWNSHIP, MI 48038-3502
(248) 475-6300
Mailing address
12339 OHIO ST, DETROIT, MI 48204-1041
(248) 499-4931
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
106S00000X
Behavior Technician
—
—
171M00000X
Case Manager/Care Coordinator
Primary
—
MI
Other
Enumeration date
04/17/2018
Last updated
02/19/2026
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