Most Relevant Information
Provider Data
| NPI Number: | 1003457110 |
| Provider Name: | KAYLA JO WALLACE |
| Entity Type: | Individual |
| Taxonomy Code: | 106S00000X |
| Specialty: | Behavior Technician |
| License Number: |
Most Important Dates
| Enumeration Date: | 10/01/2019 |
| Last Updated: | 10/01/2019 |
Provider Practice Location
4600 GARFIELD ROAD
AUBURN
MI
48611
Practice Location Phone/Fax
| Phone: | 8922663415 |
| Fax: |
Provider Mailing Location
4600 GARFIELD RD
AUBURN
MI
486119369
Provider Mailing Phone/Fax
| Phone: | 8922663415 |
| Fax: |