Healthcare Provider Details

I. General information

NPI: 1457598161
Provider Name (Legal Business Name): STEPHANIE ANN GEGG LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2009
Last Update Date: 09/29/2021
Certification Date: 08/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

715 WASHINGTON ST
STE GENEVIEVE MO
63670-1237
US

IV. Provider business mailing address

715 WASHINGTON ST
STE GENEVIEVE MO
63670-1237
US

V. Phone/Fax

Practice location:
  • Phone: 573-883-4500
  • Fax: 573-883-5957
Mailing address:
  • Phone: 573-883-4500
  • Fax: 573-883-5957

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2002019554
License Number StateMO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: