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General NPI Number Information
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NPI Number | 1699807453
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Entity Type | Individual
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Provider Name | STEPHANIE ANNE THEIS L.C.S.W., M.S.W.
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Gender | Female
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Dates
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Enumeration Date | 03/09/2007
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 921 E 34TH ST STE A
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City | JOPLIN
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State | MO
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Zip | 64804-3933
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Country | US
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Telephone | 417-623-2292
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Fax | 417-623-3328
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Provider Business Mailing Address
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Address Line | 1226 S MAIN ST
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City | CARTHAGE
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State | MO
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Zip | 64836-2712
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Country | US
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Telephone | 417-358-5653
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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 | 2004024150
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License Number State | MO
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