MEDICARE: STACEY POLLNOW BCBA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst	2021015497	MO

General Provider Information

NPI Number	:	1477283430
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STACEY POLLNOW BCBA

Provider Business Mailing Address
First Line	:	PO BOX 66726
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63166-6726
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1508 NW VIVION RD
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64118-4557
Country	:	US
Telephone Number	:	800-200-2119
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/13/2022
Last Update Date	:	06/13/2022

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