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General NPI Number Information
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NPI Number | 1942914577
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Entity Type | Individual
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Provider Name | KYNDAL JEANETTE WALLACE
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Gender | Female
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Dates
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Enumeration Date | 01/09/2023
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Last Update Date | 01/09/2023
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Provider Practice Location Address
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Address Line | 18401 TIMBER FOREST DR
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City | HUMBLE
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State | TX
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Zip | 77346-2535
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Country | US
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Telephone | 281-852-0501
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Fax |
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Provider Business Mailing Address
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Address Line | 4602 NATURAL BRIDGE DR
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City | KINGWOOD
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State | TX
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Zip | 77345-1032
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Country | US
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Telephone | 713-969-7471
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State | TX
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