Individual
JAMIE WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
24120 VAN RY BLVD STE 400, MOUNTLAKE TERRACE, WA 98043-5459
(425) 245-9940
Mailing address
24120 VAN RY BLVD STE 400, MOUNTLAKE TERRACE, WA 98043-5459
(425) 245-9940
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
CB60845593
WA
Other
Enumeration date
05/10/2022
Last updated
05/10/2022
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