MEDICARE: SHELLY R STILLMAN M.A,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	101Y00000X	Counselor	2016031782	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1538616750
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHELLY R STILLMAN M.A,PLPC

Provider Business Mailing Address
First Line	:	567 MADISON ST
Second Line	:
City	:	SAINT CHARLES
State	:	MO
Zip	:	63301-2747
Country	:	US
Telephone Number	:	636-795-5468
Fax Number	:

Provider Business Practice Location Address
First Line	:	567 MADISON ST
Second Line	:
City	:	SAINT CHARLES
State	:	MO
Zip	:	63301-2747
Country	:	US
Telephone Number	:	636-795-5468
Fax Number	:

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

Provider Enumeration Date	:	09/06/2016
Last Update Date	:	09/06/2016

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