Provider Demographics
NPI:1083202683
Name:ZUCCHINI, STEPHANIE C (PLPC)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:C
Last Name:ZUCCHINI
Suffix:
Gender:F
Credentials:PLPC
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:C
Other - Last Name:KIRKLAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1322 S CAMPBELL AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65807-1445
Mailing Address - Country:US
Mailing Address - Phone:417-761-7760
Mailing Address - Fax:417-890-7357
Practice Address - Street 1:1322 S CAMPBELL AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-1445
Practice Address - Country:US
Practice Address - Phone:417-761-7760
Practice Address - Fax:417-890-7357
Is Sole Proprietor?:No
Enumeration Date:2021-01-08
Last Update Date:2022-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2021005298101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional