Individual
MR. STEPHEN WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LMSW
Contact information
Practice address
3100 NE 83RD ST, KANSAS CITY, MO 64119-4400
(816) 468-0400
Mailing address
3100 NE 83RD ST, KANSAS CITY, MO 64119-4400
(816) 468-0400
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
2024019009
MO
106S00000X
Behavior Technician
Primary
RBT-20-130807
MO
Other
Enumeration date
08/06/2020
Last updated
06/15/2026
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