Jasen Wallace, BCBA
Behavior Analyst in Concord, CA. Individual provider (NPI-1).
NPI number1982182705
StatusActive
Last updated in NPPESMay 10, 2026
Details
- NPI
- 1982182705
- Entity type
- Individual (NPI-1)
- Name
- Jasen Wallace
- Credential
- BCBA
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Aug 2, 2018
- Certification date
- May 10, 2026
- Last updated
- May 10, 2026
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 103K00000X | Behavior Analyst | 1-22-62688 | CA | Yes |
Practice location
3437 Dormer AveConcord, CA 94519-1603
Phone 415-989-5000
Mailing address
625 Ashbury St Apt 15San Francisco, CA 94117-4703
Other practice locations
3000 El Camino Real Bldg 4
Palo Alto, CA 94306-2100
Palo Alto, CA 94306-2100
Phone 408-637-7762
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