Destiny Waller

Primary specialty

Behavior TechnicianTaxonomy code 106S00000X

Practice address

2217 E Tudor Rd Ste 3
Anchorage, AK 99507-1068

Phone

(907) 301-5471

NPI assigned

Jan 2, 2018

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Good Behavior Beginnings, LLC

  • Behavior Analyst
  • Eagle River, AK
  • NPI 1760810212
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1514851200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1514851200000",
    "number": "1336656248",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 771606",
            "city": "EAGLE RIVER",
            "state": "AK",
            "postal_code": "995771606",
            "telephone_number": "907-301-5471"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2217 E TUDOR RD STE 3",
            "city": "ANCHORAGE",
            "state": "AK",
            "postal_code": "995071068",
            "telephone_number": "907-301-5471"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLER",
        "first_name": "DESTINY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-01-02",
        "last_updated": "2018-01-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Natalie Hale Wallace, MD, MPH
• Rori Wallace, DPT
• Ryan Myles Wallace
• Sarah Beth Wallace
• Susan 'Suzi' Wallace, PSYCHOLOGIST
• Samuel Thomas Dunn Waller, MD
• Michael Walleri, DO
• Jeri R Wallin, EMT III
• Mackenzie G Wallin, BA
• Gordon Jay Wallis, LMT.

• Behavior Technician in Anchorage, AK
• Providers in Anchorage, AK by specialty
• Behavior Technician in Alaska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 2, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.