Individual
DR. PAMELA RENNE WALLEN
Active
Individual
DR. PAMELA RENNE WALLEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PSY.D.
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
2001013763
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
167106
BLUE CROSS BLUE SHIELD
MO
05
—
495281511
—
MO
01
—
614085
HEALTH LINK
MO
01
—
7994334
AETNA
MO
Enumeration date
10/26/2006
Last updated
02/21/2014
Update your record
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