Individual
STACIE WALLING
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
17412 NE 23RD ST, CHOCTAW, OK 73020-8414
(405) 626-5900
Mailing address
17412 NE 23RD ST, CHOCTAW, OK 73020-8414
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
—
Other
Enumeration date
07/19/2023
Last updated
07/19/2023
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