Provider Information for 1841313483
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REBECCA WAILING STALLWORTH LCSW
Sex: Female
NPI: 1841313483
Last Updated: 2007-07-08
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
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| NPI | 1841313483 | ||||||||
| Enumeration Date | 2007-04-09 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | 1212 N CALIFORNIA ST STOCKTON, CA 95202-1552 United States Phone: 209-468-8700 | Fax: | ||||||||
| Primary Practice Address | 1212 N CALIFORNIA ST STOCKTON, CA 95202-1552 United States Phone: 209-468-8700 | Fax: | ||||||||
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