Healthcare Provider Details

I. General information

NPI: 1033610993
Provider Name (Legal Business Name): MALLORY WALKER BCBA, M.ED.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2018
Last Update Date: 03/30/2021
Certification Date: 03/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3162 NEWBERRY DR STE 10
SAN JOSE CA
95118-1567
US

IV. Provider business mailing address

140 CHRISTOPHER AVE
CAMPBELL CA
95008-2745
US

V. Phone/Fax

Practice location:
  • Phone: 408-826-4828
  • Fax:
Mailing address:
  • Phone: 408-309-7527
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: