Individual
ZAKARY RUSSELL WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MS, BCBA, LBA
Contact information
Practice address
2427 RUSSELLVILLE RD, BOWLING GREEN, KY 42101-3980
(270) 936-7472
(317) 520-8200
Mailing address
3500 DEPAUW BLVD STE 3070, INDIANAPOLIS, IN 46268-6135
(855) 324-0885
(317) 520-8200
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
274223
KY
103K00000X
Behavior Analyst
—
—
106S00000X
Behavior Technician
RBT-19-84856
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1-21-53785
BCBA CERTIFICATE
—
01
—
RBT-19-84856
RBT
—
Enumeration date
04/24/2019
Last updated
11/01/2021
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Contact us