Laura Wallace, BCBA

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

License

BACB476683 Issued in SC

Practice address

925 Roxburgh Ave
Rock Hill, SC 29732-5505

Phone

(803) 487-8508

NPI assigned

May 14, 2020

Last updated

Oct 5, 2020By the provider in NPPES

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

Practice roles

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

• Palmetto Autism Services

  • Behavior Analyst
  • Rock Hill, SC
  • NPI 1457941908
  NPD Authorized official

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

{
    "created_epoch": "1589414400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1601856000000",
    "number": "1932721701",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "925 ROXBURGH AVE",
            "city": "ROCK HILL",
            "state": "SC",
            "postal_code": "297325505",
            "telephone_number": "803-487-8508"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "925 ROXBURGH AVE",
            "city": "ROCK HILL",
            "state": "SC",
            "postal_code": "297325505",
            "telephone_number": "803-487-8508"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "LAURA",
        "credential": "BCBA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-05-14",
        "last_updated": "2020-10-05",
        "certification_date": "2020-10-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "SC",
            "license": "BACB476683",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sha' Tonna D Walker
• Shirlise Walker
• Lesley Ann Wallace-Berman, MD
• Cynthia Wallace
• Jermaine Wallace
• Marilyn J Jewell Wallace
• Rosemarie Wallace, MSED, ATC
• Paige Walther
• Bannah Brooke Walton
• Johntoria Walton

• Behavior Analyst in Rock Hill, SC
• Providers in Rock Hill, SC by specialty
• Behavior Analyst in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2020; 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.