Healthcare Provider Details

I. General information

NPI: 1598580144
Provider Name (Legal Business Name): AMBER LEE STOKES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/19/2024
Last Update Date: 11/19/2024
Certification Date: 11/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3115 S GRAND BLVD STE 224
SAINT LOUIS MO
63118-1047
US

IV. Provider business mailing address

3250 WHITE PINE DR
IMPERIAL MO
63052-3006
US

V. Phone/Fax

Practice location:
  • Phone: 314-312-2357
  • Fax:
Mailing address:
  • Phone: 314-665-6263
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: