Individual
SADIE NOELLE WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4440 VIKING DR STE 400, BOSSIER CITY, LA 71111-7511
(318) 588-8908
(318) 588-8909
Mailing address
PO BOX 1823, WEST MONROE, LA 71294-1823
(318) 588-8908
(318) 588-8909
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
L-494
LA
106E00000X
Assistant Behavior Analyst
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1-20-43732
NATIONAL BOARD ANALYST BOARD CERTIFICATION
—
01
—
L-494
STATE LICENSE FOR BEHAVIOR ANALYST
LA
Enumeration date
04/30/2018
Last updated
03/29/2021
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