IndividualActive
Nicole Wallace
NPI 1952043754 · Behavior Technician · Jackson, MI
Provider details
- NPI number
- 1952043754
- Entity type
- Individual
- Primary specialty
- Behavior TechnicianBehavioral Health & Social Service Providers
- Sex
- Female
- Sole proprietor
- No
Specialties & taxonomies
Behavioral Health & Social Service Providers
Practice location
1211 W North St
Jackson, MI 49202-3132
Phone: (517) 513-3297
Approximate (ZIP-level) locationGet directions
Mailing address
2400 Science Pkwy
Okemos, MI 48864-2560
Registry dates
- Enumerated
- 2022-04-12
- Last updated
- 2023-01-23
- Certified
- 2023-01-23
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.