MEDICARE: STACY MARIE BROUSSARD DOULA

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	374J00000X	Doula		MO

General Provider Information

NPI Number	:	1265376891
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STACY MARIE BROUSSARD DOULA

Provider Business Mailing Address
First Line	:	872 LIGGETT AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63126-1136
Country	:	US
Telephone Number	:	314-651-0886
Fax Number	:

Provider Business Practice Location Address
First Line	:	2812 SUTTON BLVD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63143-3010
Country	:	US
Telephone Number	:	314-651-0886
Fax Number	:

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

Provider Enumeration Date	:	04/15/2026
Last Update Date	:	04/15/2026

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Directions to “ STACY MARIE BROUSSARD DOULA” Practice Location

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