Stacelynne Mack, LMSW

Primary specialty

School Social WorkerTaxonomy code 1041S0200X

License

6801082564 Issued in MI

Practice address

30601 Crest FRST
Farmington Hills, MI 48331-1052

Phone

(248) 506-4065

NPI assigned

Nov 2, 2017

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Stacelynne Wallace Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1509580800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1509580800000",
    "number": "1720590516",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 47505",
            "city": "OAK PARK",
            "state": "MI",
            "postal_code": "482375205",
            "telephone_number": "248-506-4065"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30601 CREST FRST",
            "city": "FARMINGTON HILLS",
            "state": "MI",
            "postal_code": "483311052",
            "telephone_number": "248-506-4065"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MACK",
        "first_name": "STACELYNNE",
        "credential": "LMSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-11-02",
        "last_updated": "2017-11-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041S0200X",
            "taxonomy_group": "",
            "desc": "Social Worker, School",
            "state": "MI",
            "license": "6801082564",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "STACELYNNE",
            "last_name": "WALLACE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Malika Mack
• Patricia Mack, DDS
• Precious Mack
• Shaquinta Mack
• Shayla Renee Mack
• Victoria Mack
• Siaiah Mackall
• Ta'Shauni Mackbee
• Tyler Mackelprang
• Carla Mackenna

• School Social Worker in Farmington Hills, MI
• Providers in Farmington Hills, MI by specialty
• School Social Worker in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 2017; 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.