Provider Demographics
NPI:1245069228
Name:WALLSCHLAEGER, STACY
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:
Last Name:WALLSCHLAEGER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:868 E UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85203-8033
Mailing Address - Country:US
Mailing Address - Phone:480-733-3053
Mailing Address - Fax:
Practice Address - Street 1:6950 S SILVER DR
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85249-7239
Practice Address - Country:US
Practice Address - Phone:480-579-5159
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-29
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker