Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Audrey Lucille Wallace

Individual provider Behavior Technician · NPI 1285460097

Audrey Lucille Wallace is a Behavior Technician in Jerseyville, Illinois. Licensed in Illinois. Registered with an NPI since 2024.

Licensed in
IL
In the registry since
2024

Practice location Address checks out

26034 Cemetery Rd
Jerseyville, IL 62052-6385
Phone: (618) 535-2112
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Behavior Technician (primary) Taxonomy 106S00000X (IL)

Record details

NPI number1285460097
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorNo
NPI enumeratedSeptember 9, 2024
Last updated in NPPESSeptember 9, 2024
Certification dateSeptember 9, 2024
Mailing address26034 Cemetery Rd, Jerseyville, IL 62052-6385

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