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General NPI Number Information
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NPI Number | 1326290982
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Entity Type | Individual
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Provider Name | SHANNON MCNALLY WALLACE MSW, LCSW, LCAS, CCS
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Gender | Female
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Dates
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Enumeration Date | 10/15/2008
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Last Update Date | 02/20/2023
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Provider Practice Location Address
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Address Line | LANDSTUHL REGIONAL MEDICAL CENTER UNIT 33100
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City | APO
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State | AE
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Zip | 09180-3100
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Country | US
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Telephone | 314-590-5022
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Fax |
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Provider Business Mailing Address
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Address Line | LANDSTUHL REGIONAL MEDICAL CENTER UNIT 33100
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City | APO
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State | AE
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Zip | 09180-3100
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Country | US
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Telephone | 314-590-5022
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | P004562
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | C006865
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | C006865
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License Number State | NC
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