Provider Demographics
NPI:1326236928
Name:STORCK, KELLY SHERMAN (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:SHERMAN
Last Name:STORCK
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:598 RIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63119-4272
Mailing Address - Country:US
Mailing Address - Phone:314-968-8819
Mailing Address - Fax:
Practice Address - Street 1:9920 WATSON RD
Practice Address - Street 2:STE. 114
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63126-1834
Practice Address - Country:US
Practice Address - Phone:314-540-8593
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-09
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO19991380031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical