Individual
ASHLEY KATHLEEN WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.S., BCBA, LABA
Contact information
Practice address
11 HURON DR, NATICK, MA 01760-1336
(508) 651-7500
Mailing address
11 HURON DR, NATICK, MA 01760-1336
(508) 651-7500
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-13-14833
VA
Other
Enumeration date
09/14/2015
Last updated
04/04/2017
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