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NPI Code Detail

MEDICARE: LEONA P. BUTTLER WALLACE

MEDICARE: LEONA P. BUTTLER WALLACE
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior TechnicianNJ

General Provider Information

NPI Number : 1184559924
Entity Type Code : Individual
Provider Name (Legal Business Name) : LEONA P. BUTTLER WALLACE
Provider Business Mailing Address
First Line : 1333 S MAYFLOWER AVE STE 220
Second Line :
City : MONROVIA
State : CA
Zip : 91016-5239
Country : US
Telephone Number : 818-241-6780
Fax Number : 888-588-2752
Provider Business Practice Location Address
First Line : 181 NEW RD STE 304
Second Line :
City : PARSIPPANY
State : NJ
Zip : 07054-5625
Country : US
Telephone Number : 855-295-3276
Fax Number : 888-588-2752
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/15/2026
Last Update Date : 06/18/2026

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Directions to “ LEONA P. BUTTLER WALLACE ” Practice Location

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