Provider Demographics
NPI:1154743151
Name:SCALLION, JOHN MATTHEW (MSW, LICSW)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:MATTHEW
Last Name:SCALLION
Suffix:
Gender:
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:MATT
Other - Middle Name:
Other - Last Name:SCALLION
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSW, LICSW, LCSW
Mailing Address - Street 1:224 W MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64050-2816
Mailing Address - Country:US
Mailing Address - Phone:816-381-7690
Mailing Address - Fax:816-381-7652
Practice Address - Street 1:224 W MAPLE AVE
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64050-2816
Practice Address - Country:US
Practice Address - Phone:816-381-7690
Practice Address - Fax:612-925-8496
Is Sole Proprietor?:No
Enumeration Date:2014-01-09
Last Update Date:2025-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
MO20220156521041C0700X
MN272441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker