MEDICARE: DIANNA STALLINGS

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	1041C0700X	Clinical Social Worker	DP00945133	WV
2	1041C0700X	Clinical Social Worker	34009483A	IN

General Provider Information

NPI Number	:	1922526144
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANNA STALLINGS

Provider Business Mailing Address
First Line	:	8520 ALLISON POINTE BLVD STE 220
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46250-4299
Country	:	US
Telephone Number	:	619-302-3697
Fax Number	:

Provider Business Practice Location Address
First Line	:	17 N 5TH AVE # 1029
Second Line	:
City	:	BEECH GROVE
State	:	IN
Zip	:	46107-1325
Country	:	US
Telephone Number	:	619-302-3697
Fax Number	:

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

Provider Enumeration Date	:	09/08/2017
Last Update Date	:	01/25/2023

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Directions to “ DIANNA STALLINGS ” Practice Location

Language	Start Address	Practice Location

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