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DR. AMANDA JO WALLACE PSY.D.
NPI 1972908010
Psychologist - Clinical in Poplar Bluff, MO

Active since October 31, 2014
1500 N WESTWOOD BLVD, POPLAR BLUFF, MO 63901(573) 778-4122 Get Directions Write a Review

NPPES record last updated: October 31, 2014. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Dr. Amanda Jo Wallace Psy.d. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. AMANDA JO WALLACE PSY.D. (NPI 1972908010) is an individual clinical provider in Poplar Bluff, Missouri, licensed in Missouri (2009031094) and active in the NPI registry since October 2014.

NPPES Registry Identity

NPI1972908010
Entity TypeIndividualFemale
Primary Taxonomy103TC0700X
Provider Legal NameDR. AMANDA JO WALLACECredential: PSY.D.
Location Address1500 N WESTWOOD BLVDPoplar Bluff, MO 63901-3318
Mailing Address1500 N Westwood BlvdPoplar Bluff, MO 63901-3318 · (573) 778-4122
Phone(573) 778-4122
Sole ProprietorNo
Enumeration DateOctober 31, 2014
✔ NPI 1972908010 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyPsychologist · ClinicalBehavioral Health & Social Service Providers
Taxonomy Code103TC0700X
License✔ Licensed in MO · 2009031094
Definition
A psychologist who provides continuing and comprehensive mental and behavioral health care for individuals and families; consultation to agencies and communities; training, education and supervision; and research-based practice. It is a specialty in breadth -- one that is broadly inclusive of severe psychopathology -- and marked by comprehensiveness and integration of knowledge and skill from a broad array of disciplines within and outside of psychology proper. The scope of clinical psychology encompasses all ages, multiple diversities and varied systems.
Also ListedPsychologist · ForensicTaxonomy 103TF0200X · License 2009031094 (MO)
1500 N WESTWOOD BLVD, Poplar Bluff, MO 63901
Open in Google Maps ↗

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. KAYLA S MELTON O.D.
Optometrist
1500 N WESTWOOD BLVD
POPLAR BLUFF, MO 63901
Butler County (573) 778-4303
DR. MERCY RATHINI SABAPATHYPILLAI M.D.
Psychiatry & Neurology (Psychiatry)
1500 N WESTWOOD BLVD
POPLAR BLUFF, MO 63901
Butler County (573) 472-2139
AMANDA RENAE FLORY D.O.
Psychiatry & Neurology (Psychiatry)
1500 N WESTWOOD BLVD
POPLAR BLUFF, MO 63901
Butler County (573) 686-4151
MAGEN BARNES
Registered Nurse
1500 N WESTWOOD BLVD
POPLAR BLUFF, MO 63901
Butler County (573) 686-4151
MS. JOLENE M WOLF FNP
Nurse Practitioner
1500 N WESTWOOD BLVD
POPLAR BLUFF, MO 63901
Butler County (573) 686-4151
MR. OSCAR BRIAN SMITH I RRT
Respiratory Therapist, Registered
1500 N WESTWOOD BLVD
POPLAR BLUFF, MO 63901
Butler County (573) 686-4151
ROCHELLE POYNOR RRT
Respiratory Therapist, Registered
1500 N WESTWOOD BLVD
POPLAR BLUFF, MO 63901
Butler County (573) 686-4151
PAMELA G HARNESS LCSW
Social Worker (Clinical)
1500 N WESTWOOD BLVD
POPLAR BLUFF, MO 63901
Butler County (573) 686-4151

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Amanda Wallace's NPI number?

The NPI number for Amanda Wallace is 1972908010. It was assigned to this individual provider in the NPPES registry on October 31, 2014.

Where is Amanda Wallace located?

Amanda Wallace practices at 1500 N Westwood Blvd, Poplar Bluff, MO 63901. The listed phone number is (573) 778-4122.

What is Amanda Wallace's specialty?

The primary specialty registered for this NPI is Psychologist, specializing in Clinical, with taxonomy code 103TC0700X.

When was this NPI record last updated?

The NPPES record for Amanda Wallace was last updated on October 31, 2014. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 11 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.