Provider Demographics
NPI:1952518771
Name:STALLBAUMER, VALERIE A (LAC)
Entity Type:Individual
Prefix:MS
First Name:VALERIE
Middle Name:A
Last Name:STALLBAUMER
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:431 S DUFF AVE STE B
Mailing Address - Street 2:
Mailing Address - City:AMES
Mailing Address - State:IA
Mailing Address - Zip Code:50010-6606
Mailing Address - Country:US
Mailing Address - Phone:515-232-2979
Mailing Address - Fax:515-232-2979
Practice Address - Street 1:431 S DUFF AVE STE B
Practice Address - Street 2:
Practice Address - City:AMES
Practice Address - State:IA
Practice Address - Zip Code:50010-6606
Practice Address - Country:US
Practice Address - Phone:515-232-2979
Practice Address - Fax:515-232-2979
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2019-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA-7171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist