Individual
MALLORY WALTERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BCBA
Contact information
Practice address
138 FIELD GROVE CT, EAST PEORIA, IL 61611-4323
(713) 732-7049
Mailing address
138 FIELD GROVE CT, EAST PEORIA, IL 61611-4323
(713) 732-7049
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-22-59328
IL
Other
Enumeration date
03/19/2021
Last updated
06/07/2024
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