Individual
HALEY ANNE WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1390 MILLER ST, HONOLULU, HI 96813-2493
(808) 441-8364
Mailing address
1923 DUDOIT LN APT 4, HONOLULU, HI 96815-1731
(970) 343-0466
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
BACB676884
HI
Other
Enumeration date
10/06/2021
Last updated
10/06/2021
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