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NPI Code Detail

MEDICARE: JENNA MICHELLE WALLACE

MEDICARE: JENNA MICHELLE 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 TechnicianAL

General Provider Information

NPI Number : 1447100128
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNA MICHELLE WALLACE
Provider Business Mailing Address
First Line : 151 NARROWS PKWY STE E
Second Line :
City : BIRMINGHAM
State : AL
Zip : 35242-8638
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 151 NARROWS PKWY STE E
Second Line :
City : BIRMINGHAM
State : AL
Zip : 35242-8638
Country : US
Telephone Number : 312-386-6820
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/02/2026
Last Update Date : 02/02/2026

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Directions to “ JENNA MICHELLE WALLACE ” Practice Location

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