Wallace, Amanda Jo

Wallace, Amanda Jo is an individual health care provider with primary practice located at 1500 N Westwood Blvd , Poplar Bluff MO 63901-3318. She recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Clinical, Behavioral Health & Social Service Providers / Forensic. Behavioral Health & Social Service Providers / Clinical is her primary health care specialty. Wallace, Amanda Jo can be contacted via phone (573) 778-4122.

Contact Information

Primary practice address
1500 N Westwood Blvd Poplar Bluff MO 63901-3318
Phone: (573) 778-4122
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Clinical 103TC0700X 2009031094 Missouri
Behavioral Health & Social Service Providers / Forensic 103TF0200X 2009031094 Missouri

Profile Details

NPI number 1972908010
LBN Legal business name Wallace, Amanda Jo
Credentials PSY.D.
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 31st, 2014
Last updated Oct 31st, 2014 - about 12 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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