Individual
ELIZABETH WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3500 7TH AVE S, BIRMINGHAM, AL 35222-3211
(205) 963-7682
(317) 520-8200
Mailing address
5360 PARK SIDE CIR, HOOVER, AL 35244-5142
(225) 620-8432
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
106S00000X
Behavior Technician
—
—
Other
Enumeration date
06/29/2021
Last updated
11/15/2022
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