Provider Demographics
NPI:1285340497
Name:STALLWORTH, DANIELLE (CPSS)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:STALLWORTH
Suffix:
Gender:F
Credentials:CPSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 S 24TH ST
Mailing Address - Street 2:STE 230
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68102-1226
Mailing Address - Country:US
Mailing Address - Phone:877-518-1070
Mailing Address - Fax:
Practice Address - Street 1:2301 O ST
Practice Address - Street 2:STE 1
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68510-1124
Practice Address - Country:US
Practice Address - Phone:402-441-7940
Practice Address - Fax:402-441-8625
Is Sole Proprietor?:No
Enumeration Date:2023-01-31
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NECPSS-182175T00000X, 171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No175T00000XOther Service ProvidersPeer Specialist