Individual
PAMELA LEE WANTUCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
440 S MARKET AVE, SPRINGFIELD, MO 65806-2026
(417) 225-2554
Mailing address
440 S MARKET AVE, SPRINGFIELD, MO 65806-2026
(417) 225-2554
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
2005021042
MO
Other
Enumeration date
10/07/2009
Last updated
04/28/2010
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