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General NPI Number Information
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NPI Number | 1629218862
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Entity Type | Organization
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Legal Business Name | STEFANI POELKER, MSW, LCSW, LLC
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Dates
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Enumeration Date | 02/28/2009
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Last Update Date | 02/28/2009
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Provider Practice Location Address
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Address Line | 777 CRAIG RD SUITE 230
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City | SAINT LOUIS
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State | MO
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Zip | 63141-7138
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Country | US
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Telephone | 314-210-8424
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Fax | 314-298-0020
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Provider Business Mailing Address
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Address Line | 4 CALDER CT
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City | MANCHESTER
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State | MO
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Zip | 63021-6406
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Country | US
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Telephone | 314-210-8424
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Fax | 314-298-0020
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Authorized Official
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Title or Position | OWNER
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Name | MS. STEFANI JEAN POELKER
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Credential | MSW, LCSW
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Telephone | 314-210-8424
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 2004000868
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License Number State | MO
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