Healthcare Provider Details

I. General information

NPI: 1871959379
Provider Name (Legal Business Name): STEPHENIE L FICHTENMAYER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: STEPHENIE L WALLACE

II. Dates (important events)

Enumeration Date: 01/13/2016
Last Update Date: 09/09/2025
Certification Date: 09/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

231 S BEMISTON AVE STE 850
SAINT LOUIS MO
63105-1920
US

IV. Provider business mailing address

231 S BEMISTON AVE STE 850
SAINT LOUIS MO
63105-1920
US

V. Phone/Fax

Practice location:
  • Phone: 636-206-6315
  • Fax:
Mailing address:
  • Phone: 636-206-6315
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2018009776
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: