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NPI Code Detail

MEDICARE: STEPHANIE CLUBB LCSW

MEDICARE: STEPHANIE CLUBB LCSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker2015024020MO
21041C0700XClinical Social Worker149018328IL

General Provider Information

NPI Number : 1194264200
Entity Type Code : Individual
Provider Name (Legal Business Name) : STEPHANIE CLUBB LCSW
Provider Business Mailing Address
First Line : 900 E LAHARPE ST
Second Line :
City : KIRKSVILLE
State : MO
Zip : 63501-4520
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1601 OLD SOUTH RIVER RD
Second Line :
City : SAINT CHARLES
State : MO
Zip : 63303-4120
Country : US
Telephone Number : 636-224-1100
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/22/2017
Last Update Date : 02/22/2017

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Directions to “ STEPHANIE CLUBB LCSW” Practice Location

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