Healthcare Provider Details

I. General information

NPI: 1902341209
Provider Name (Legal Business Name): JALA WILSON BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JALA SIMMONS

II. Dates (important events)

Enumeration Date: 12/22/2016
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 E MOUND RD STE 100
DECATUR IL
62526-2771
US

IV. Provider business mailing address

1301 E MOUND RD STE 100
DECATUR IL
62526-2771
US

V. Phone/Fax

Practice location:
  • Phone: 217-970-2040
  • Fax:
Mailing address:
  • Phone: 217-970-2040
  • 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 Number1-20-45615
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: