Shawnesha Wallace, BCBA, LBA

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

License

BEH-000379 Issued in AZ

Practice address

1200 N El Dorado PL Ste G700
Tucson, AZ 85715-4637

Phone

(520) 526-0050

NPI assigned

Feb 9, 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

State licenses

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

{
    "created_epoch": "1518134400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1545264000000",
    "number": "1407355019",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10214 E CALLE ESTRELLA POLAR",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857475169",
            "telephone_number": "520-230-6965"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 N EL DORADO PL STE G700",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857154637",
            "telephone_number": "520-526-0050"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "SHAWNESHA",
        "name_prefix": "Mrs.",
        "credential": "BCBA, LBA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-02-09",
        "last_updated": "2018-12-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "AZ",
            "license": "BEH-000379",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jan Ellen Wallace, LCSW
• Michelle Wallace, PHARMD
• Neil Wallace, MD
• Robert Dean Wallace, PT
• Ryan Wallace, P.T., D.P.T.
• Stephanie Wallace, PA-C
• Steven B Wallach, D.O.
• Keira Wallenborn, MA, CCC-SLP
• Kaylee Wallentine
• Candice Waller, LPC-MHSP

• Behavior Analyst in Tucson, AZ
• Providers in Tucson, AZ by specialty
• Behavior Analyst in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 20, 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.