Provider Demographics
NPI:1417168113
Name:WILLIAMS, STEPHANIE DIANE (MSW)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:DIANE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 W MONROE AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63122-5815
Mailing Address - Country:US
Mailing Address - Phone:314-909-9922
Mailing Address - Fax:314-909-1831
Practice Address - Street 1:2705 DOUGHERTY FERRY RD STE 103
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63122-3372
Practice Address - Country:US
Practice Address - Phone:314-329-7107
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2019-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20040245001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical