Provider Demographics
NPI:1932637139
Name:MARKWALTER, VANN (BCBA)
Entity type:Individual
Prefix:
First Name:VANN
Middle Name:
Last Name:MARKWALTER
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9000 SOUTHSIDE BLVD BLDG 900
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-0791
Mailing Address - Country:US
Mailing Address - Phone:904-732-4343
Mailing Address - Fax:
Practice Address - Street 1:9000 SOUTHSIDE BLVD BLDG 900
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-0791
Practice Address - Country:US
Practice Address - Phone:904-732-4343
Practice Address - Fax:904-562-3466
Is Sole Proprietor?:No
Enumeration Date:2017-06-01
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1-18-32635103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst