=====================================================
General NPI Number Information
=====================================================
NPI Number | 1720172851
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TARA LYNNE SCHAPER MSW, LCSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/03/2006
-----------------------------------------------------
Last Update Date | 01/16/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11255 OLIVE BLVD
-----------------------------------------------------
City | CREVE COEUR
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63141-7652
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-475-3005
-----------------------------------------------------
Fax | 314-475-3007
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 441 FORDER RD
-----------------------------------------------------
City | SAINT LOUIS
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63129-2639
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-487-4496
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 2012021202
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------