Individual
COREY JAMES WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RBT
Contact information
Practice address
442 SAND CREEK DR STE 101, CHESTERTON, IN 46304-1596
(219) 359-3272
Mailing address
442 SAND CREEK DR STE 101, CHESTERTON, IN 46304-1596
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
08/06/2025
Last updated
08/06/2025
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