Individual
JESSICA WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
420 OAKLAND AVE, STATEN ISLAND, NY 10310-2133
(646) 633-3655
Mailing address
420 OAKLAND AVE, STATEN ISLAND, NY 10310-2133
(646) 633-3655
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
NJ
Other
Enumeration date
09/29/2025
Last updated
09/29/2025
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