Jordan Wallek, BCABA

Primary specialty

Assistant Behavior AnalystTaxonomy code 106E00000X

License

C-058 Issued in LA

Practice address

10450 Ellebre Road
Shreveport, LA 71106

Phone

(318) 797-8500

Fax

(318) 629-2735

NPI assigned

Feb 3, 2022

Sex

Female

Sole proprietor

Yes

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": "1643846400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1689552000000",
    "number": "1801549373",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3253 SCHULER DRIVE",
            "city": "BOSSIER CITY",
            "state": "LA",
            "postal_code": "711125129",
            "telephone_number": "708-821-6255"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10450 ELLEBRE ROAD",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "71106",
            "telephone_number": "318-797-8500",
            "fax_number": "318-629-2735"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLEK",
        "first_name": "JORDAN",
        "credential": "BCABA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-02-03",
        "last_updated": "2023-07-17",
        "certification_date": "2023-07-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106E00000X",
            "taxonomy_group": "",
            "desc": "Assistant Behavior Analyst",
            "state": "LA",
            "license": "C-058",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Assistant Behavior Analyst in Shreveport, LA
• Providers in Shreveport, LA by specialty
• Assistant Behavior Analyst in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2023; 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.