Provider Demographics
NPI:1154302198
Name:STOOS, DAVID M (MA LICSW)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:M
Last Name:STOOS
Suffix:
Gender:M
Credentials:MA LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:166 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WINONA
Mailing Address - State:MN
Mailing Address - Zip Code:55987-3405
Mailing Address - Country:US
Mailing Address - Phone:507-454-4341
Mailing Address - Fax:507-453-6267
Practice Address - Street 1:166 MAIN ST
Practice Address - Street 2:
Practice Address - City:WINONA
Practice Address - State:MN
Practice Address - Zip Code:55987-3405
Practice Address - Country:US
Practice Address - Phone:507-454-4341
Practice Address - Fax:507-453-6267
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6595103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN32Q27STOtherBCBS
MN141921OtherUCARE