Provider Demographics
NPI:1629218862
Name:STEFANI POELKER, MSW, LCSW, LLC
Entity Type:Organization
Organization Name:STEFANI POELKER, MSW, LCSW, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:STEFANI
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:POELKER
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW
Authorized Official - Phone:314-210-8424
Mailing Address - Street 1:4 CALDER CT
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:MO
Mailing Address - Zip Code:63021-6406
Mailing Address - Country:US
Mailing Address - Phone:314-210-8424
Mailing Address - Fax:314-298-0020
Practice Address - Street 1:777 CRAIG RD
Practice Address - Street 2:SUITE 230
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-7138
Practice Address - Country:US
Practice Address - Phone:314-210-8424
Practice Address - Fax:314-298-0020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-28
Last Update Date:2009-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004000868251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health