Provider Demographics
NPI:1114297363
Name:KORPAL, STEPHANIE C (MED)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:C
Last Name:KORPAL
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7527 WISE AVE
Mailing Address - Street 2:APARTMENT B
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63117-1538
Mailing Address - Country:US
Mailing Address - Phone:314-323-8364
Mailing Address - Fax:
Practice Address - Street 1:6816 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63130-4628
Practice Address - Country:US
Practice Address - Phone:314-222-4872
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-05
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011039350101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional