Healthcare Provider Details

I. General information

NPI: 1144595521
Provider Name (Legal Business Name): MELISSA STIFFLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2012
Last Update Date: 06/25/2020
Certification Date: 06/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2808 S PICHER AVE
JOPLIN MO
64804-1645
US

IV. Provider business mailing address

3220 WISCONSIN AVE
JOPLIN MO
64804-4017
US

V. Phone/Fax

Practice location:
  • Phone: 417-347-7850
  • Fax:
Mailing address:
  • Phone: 417-347-7850
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number2020015316
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: