Jordan Cornell Wallace
NPI #1689449787 in Cathedral City, California
Provider Information
- NPI Number
- 1689449787
- Entity Type
- Individual
- Name
- Jordan Cornell Wallace
- Gender
- Not Specified
- Sole Proprietor
- Yes
- Primary Specialty
- Behavior Technician
- Enumeration Date
- Nov 17, 2023
- Last Updated
- Nov 17, 2023
Practice Location
- Address
- 69155 DINAH SHORE DR
- City
- Cathedral City
- State
- California
- ZIP Code
- 92234-4792
- Phone
- (760) 969-9383
Specialties & Taxonomy Codes
| Specialty |
|---|
| Behavior Technician |
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