Individual
MRS. PAMELA JUNE STACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA, ATR-BC, LCSW
Contact information
Practice address
330 N GORE AVE, WEBSTER GROVES, MO 63119-1600
(314) 919-4700
(314) 968-2375
Mailing address
11 VILLAWOOD LN, WEBSTER GROVES, MO 63119-4916
(314) 570-6439
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
002178
MO
Other
Enumeration date
05/18/2007
Last updated
07/08/2007
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