Provider Demographics
NPI:1891260246
Name:GILLEN, STEPHANIE (MSW)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:GILLEN
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 1:12110 CLAYTON RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63131-2599
Mailing Address - Country:US
Mailing Address - Phone:314-666-4191
Mailing Address - Fax:
Practice Address - Street 1:2200 BROWN RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63114-5512
Practice Address - Country:US
Practice Address - Phone:314-666-4191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-11
Last Update Date:2018-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker