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

Jordan Cornell Wallace

Individual provider Behavior Technician · NPI 1689449787

Jordan Cornell Wallace is a Behavior Technician in Cathedral City, California. Practices as a sole proprietor. Registered with an NPI since 2023.

In the registry since
2023

Practice location Address checks out

69155 Dinah Shore Dr
Cathedral City, CA 92234-4792
Phone: (760) 969-9383
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Behavior Technician (primary) Taxonomy 106S00000X

Record details

NPI number1689449787
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorYes
NPI enumeratedNovember 17, 2023
Last updated in NPPESNovember 17, 2023
Certification dateNovember 17, 2023
Mailing address69155 Dinah Shore Dr, Cathedral City, CA 92234-4792

Other providers in Cathedral City