Jordan Cornell Wallace
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 DrCathedral City, CA 92234-4792
Phone: (760) 969-9383
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Specialties & licences
| Behavior Technician (primary) | Taxonomy 106S00000X |
|---|
Record details
| NPI number | 1689449787 |
|---|---|
| Entity type | Individual (Type 1) |
| Gender | Male |
| Sole proprietor | Yes |
| NPI enumerated | November 17, 2023 |
| Last updated in NPPES | November 17, 2023 |
| Certification date | November 17, 2023 |
| Mailing address | 69155 Dinah Shore Dr, Cathedral City, CA 92234-4792 |
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