IndividualActive
Nicole Wallace, I.S.
NPI 1083446405 · Assistant Behavior Analyst · Idaho Falls, ID
Provider details
- NPI number
- 1083446405
- Entity type
- Individual
- Primary specialty
- Assistant Behavior AnalystBehavioral Health & Social Service Providers
- Credential
- I.S.
- Sex
- Female
- Sole proprietor
- Yes
Specialties & taxonomies
Behavioral Health & Social Service Providers
Practice location
2185 Koro Ave
Idaho Falls, ID 83404-6226
Phone: (520) 233-3382
Approximate (ZIP-level) locationGet directions
Mailing address
2185 Koro Ave
Idaho Falls, ID 83404-6226
Registry dates
- Enumerated
- 2024-08-14
- Last updated
- 2024-08-14
- Certified
- 2024-08-14
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.