MEDICARE: MS. STEPHANIE ANN WHITE LCSW

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	1041C0700X	Clinical Social Worker	09047005918	VA
2	1041C0700X	Clinical Social Worker	2011041571	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	186803	OTHER	VA	ANTHEM HEALTHKEEPERS
3	186803	OTHER	VA	ANTHEM PPO BCBS

General Provider Information

NPI Number	:	1952364267
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. STEPHANIE ANN WHITE LCSW

Provider Business Mailing Address
First Line	:	5950 N OAK TRFY
Second Line	:	STE 104
City	:	GLADSTONE
State	:	MO
Zip	:	64118-5166
Country	:	US
Telephone Number	:	816-455-7223
Fax Number	:	816-455-7224

Provider Business Practice Location Address
First Line	:	5950 N OAK TRFY
Second Line	:	STE 104
City	:	GLADSTONE
State	:	MO
Zip	:	64118-5166
Country	:	US
Telephone Number	:	816-455-7223
Fax Number	:	816-455-7224

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

Provider Enumeration Date	:	04/08/2006
Last Update Date	:	05/30/2012

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