MEDICARE: MRS. STACY NICOLE KILE MS, MA, CCCSLP, PLPC

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
1	101YM0800X	Mental Health Counselor
2	235Z00000X	Speech-Language Pathologist	SZ4252	FL
3	235Z00000X	Speech-Language Pathologist		MO
4	101YM0800X	Mental Health Counselor		MO

General Provider Information

NPI Number	:	1427248178
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. STACY NICOLE KILE MS, MA, CCCSLP, PLPC

Provider Business Mailing Address
First Line	:	35 JACKS CABIN DR
Second Line	:
City	:	DEFIANCE
State	:	MO
Zip	:	63341-1329
Country	:	US
Telephone Number	:	314-616-9609
Fax Number	:

Provider Business Practice Location Address
First Line	:	1715 DEER TRACKS TRL STE 260
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63131-1855
Country	:	US
Telephone Number	:	314-616-9609
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/30/2007
Last Update Date	:	05/12/2021

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