Healthcare Provider Details

I. General information

NPI: 1962361758
Provider Name (Legal Business Name): STEPHANIE M BRECKENRIDGE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: STEPHANIE HERRING

II. Dates (important events)

Enumeration Date: 01/19/2026
Last Update Date: 01/19/2026
Certification Date: 01/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

307 W 11TH ST
LAMAR MO
64759-1428
US

IV. Provider business mailing address

PO BOX 2526
JOPLIN MO
64803-2526
US

V. Phone/Fax

Practice location:
  • Phone: 417-347-6475
  • Fax:
Mailing address:
  • Phone: 417-347-7579
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2025044948
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: