Individual
STACEY BACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1721 W ELFINDALE ST STE B, SPRINGFIELD, MO 65807-1295
(417) 874-1906
Mailing address
2864 S NETTLETON AVE, SPRINGFIELD, MO 65807-5970
(417) 874-1906
(417) 771-3723
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
Other
Enumeration date
04/19/2024
Last updated
04/04/2025
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