Individual
GEENA WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
125 BROOMALL ST APT B, FOLSOM, PA 19033-2732
(215) 840-0971
Mailing address
125 BROOMALL ST APT B, FOLSOM, PA 19033-2732
(215) 840-0971
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-21-52064
PA
Other
Enumeration date
01/17/2022
Last updated
01/17/2022
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