Healthcare Provider Details

I. General information

NPI: 1952364267
Provider Name (Legal Business Name): STEPHANIE ANN WHITE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2006
Last Update Date: 05/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5950 N OAK TRFY STE 104
GLADSTONE MO
64118-5166
US

IV. Provider business mailing address

5950 N OAK TRFY STE 104
GLADSTONE MO
64118-5166
US

V. Phone/Fax

Practice location:
  • Phone: 816-455-7223
  • Fax: 816-455-7224
Mailing address:
  • Phone: 816-455-7223
  • Fax: 816-455-7224

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number09047005918
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2011041571
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: