MEDICARE: STEPHANIE C KORPAL M.ED.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	2011039350	MO

General Provider Information

NPI Number	:	1114297363
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE C KORPAL M.ED.

Provider Business Mailing Address
First Line	:	7527 WISE AVE
Second Line	:	APARTMENT B
City	:	SAINT LOUIS
State	:	MO
Zip	:	63117-1538
Country	:	US
Telephone Number	:	314-323-8364
Fax Number	:

Provider Business Practice Location Address
First Line	:	6816 WASHINGTON AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63130-4628
Country	:	US
Telephone Number	:	314-222-4872
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/05/2012
Last Update Date	:	01/05/2012

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