Individual
JORDAN WALLEK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
BCABA
Contact information
Practice address
10450 ELLEBRE ROAD, SHREVEPORT, LA 71106
(318) 797-8500
(318) 629-2735
Mailing address
3253 SCHULER DRIVE, BOSSIER CITY, LA 71112-5129
(708) 821-6255
Taxonomy
Speciality
Code
Description
License number
State
106E00000X
Assistant Behavior Analyst
Primary
C-058
LA
Other
Enumeration date
02/03/2022
Last updated
07/17/2023
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