Provider Demographics
NPI:1841767688
Name:STACY, ANDREA (CGC)
Entity Type:Individual
Prefix:MS
First Name:ANDREA
Middle Name:
Last Name:STACY
Suffix:
Gender:F
Credentials:CGC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 60352
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63160-0352
Mailing Address - Country:US
Mailing Address - Phone:314-454-6018
Mailing Address - Fax:844-621-4392
Practice Address - Street 1:1 CHILDRENS PL
Practice Address - Street 2:DIV PED HEMATOLOGY AND ONC
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1002
Practice Address - Country:US
Practice Address - Phone:314-454-6018
Practice Address - Fax:844-621-4392
Is Sole Proprietor?:No
Enumeration Date:2018-10-30
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS