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General NPI Number Information
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NPI Number | 1457087223
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Entity Type | Individual
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Provider Name | MS. STACEY MILLER
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Gender | Female
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Dates
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Enumeration Date | 07/25/2022
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Last Update Date | 07/25/2022
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Provider Practice Location Address
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Address Line | 1034 S BRENTWOOD BLVD STE 555
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City | RICHMOND HEIGHTS
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State | MO
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Zip | 63117-1265
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Country | US
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Telephone | 314-665-0224
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Fax |
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Provider Business Mailing Address
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Address Line | 915 DEANDELL AVE
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City | FERGUSON
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State | MO
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Zip | 63135-1750
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Country | US
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Telephone | 314-494-7455
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 1999140930
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License Number State | MO
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