Jack Moran Stallard II

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

S0500276 Issued in OH

Practice address

7162 Reading Rd Ste 300
Cincinnati, OH 45237-3899

Phone

(513) 961-5900

Fax

(513) 961-5903

NPI assigned

Jan 4, 2018

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Camelot Community Care, Inc

  • Community/Behavioral Health Agency
  • Cincinnati, OH
  • NPI 1063771780
  NPD (past)
• Camelot Community Care, Inc.

  • Community/Behavioral Health Agency
  • Clearwater, FL
  • NPI 1679581250

  Clinical

  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1515024000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1515024000000",
    "number": "1265949945",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7162 READING RD STE 300",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452373899",
            "telephone_number": "513-961-5900",
            "fax_number": "513-961-5903"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7162 READING RD STE 300",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452373899",
            "telephone_number": "513-961-5900",
            "fax_number": "513-961-5903"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STALLARD",
        "first_name": "JACK",
        "middle_name": "MORAN",
        "name_suffix": "II",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-01-04",
        "last_updated": "2018-01-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OH",
            "license": "S0500276",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ronna L Staley, M.D.
• Veronica Staley
• Stephanie Stalf, MS, ATC
• Sonya Stalker, SWA
• Claire Stall, PHARMD
• Charen Stallings
• Zoe C Stallings
• Angela Stallo-Kramer
• Dennis Lee Stallo
• Johnna Stallo

• Clinical Social Worker in Cincinnati, OH
• Providers in Cincinnati, OH by specialty
• Clinical Social Worker in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.