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General NPI Number Information
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NPI Number | 1689618514
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Entity Type | Individual
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Provider Name | GLEN EUGENE STOVALL M.S.W.
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Gender | Male
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Dates
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Enumeration Date | 06/14/2006
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Last Update Date | 09/29/2010
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Provider Practice Location Address
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Address Line | 645 E IRON AVE SUITE D
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City | SALINA
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State | KS
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Zip | 67401-2697
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Country | US
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Telephone | 785-827-2700
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Fax | 785-309-0184
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Provider Business Mailing Address
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Address Line | 645 E IRON AVE SUITE D
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City | SALINA
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State | KS
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Zip | 67401-2697
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Country | US
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Telephone | 785-827-2700
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Fax | 785-309-0184
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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 | LSCSW 1078
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License Number State | KS
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