| Doctor Name: | MR. JASON D WALLACE |
| NPI Number: | 1679713754 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | BCBA |
| License Number: | 1-04-1845 |
| Business Practice Address: | 104 Shoreview Ln Oldsmar, FL - 346774106 |
| Business Phone Number: | 8135469867 |
| Business Fax Number: | 8138180510 |
| Mailing Address: | 104 Shoreview Ln, OLDSMAR |
| State: | FL |
| Postal Code: | 346774106 |
| Phone Number: | 8135469867 |
| Fax Number: | 8138180510 |
| NPI Enumeration Date: | 03/02/2009 |
| NPI Last Update Date: | 03/02/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103K00000X |
| License Number: | 1-04-1845 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Behavioral Analyst |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A Behavior Analyst is a practitioner who specializes in analysis of behavior problems and development of appropriate intervention and treatment plans. A Behavior Analyst may work independently or with a team of professionals. Behavior Analysts often specialize in a particular area such as autism, developmental disabilities, mental health, geriatrics, or head trauma. |