Provider Demographics
NPI:1003883000
Name:DRAPER-STUCK, REBECCA (LCSW)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:DRAPER-STUCK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2303 VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64506-4954
Mailing Address - Country:US
Mailing Address - Phone:816-232-4417
Mailing Address - Fax:816-671-0961
Practice Address - Street 1:2303 VILLAGE DR
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64506-4954
Practice Address - Country:US
Practice Address - Phone:816-232-4417
Practice Address - Fax:816-671-0961
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2009-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0055631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO494686215Medicaid
KS100288780DMedicaid
F29A103AMedicare ID - Type Unspecified
KS100288780DMedicaid
MO494686215Medicaid