Provider Demographics
NPI:1700433497
Name:STALLMAN, STACEY PAPPAS (LISW)
Entity type:Individual
Prefix:
First Name:STACEY
Middle Name:PAPPAS
Last Name:STALLMAN
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:STACEY
Other - Middle Name:
Other - Last Name:PAPACOSTAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:808 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50309-1307
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6000 UNIVERSITY AVE STE 200
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-8201
Practice Address - Country:US
Practice Address - Phone:515-241-2300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-19
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA0952201041C0700X
1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical