Provider Demographics
NPI:1184694671
Name:POELKER, STEFANI (LCSW)
Entity type:Individual
Prefix:
First Name:STEFANI
Middle Name:
Last Name:POELKER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 OSAGE EXECUTIVE CIR
Mailing Address - Street 2:
Mailing Address - City:HOUSE SPRINGS
Mailing Address - State:MO
Mailing Address - Zip Code:63051-1382
Mailing Address - Country:US
Mailing Address - Phone:636-677-9977
Mailing Address - Fax:636-677-9179
Practice Address - Street 1:100 OSAGE EXECUTIVE CIR
Practice Address - Street 2:
Practice Address - City:HOUSE SPRINGS
Practice Address - State:MO
Practice Address - Zip Code:63051-1382
Practice Address - Country:US
Practice Address - Phone:636-677-9977
Practice Address - Fax:636-677-9179
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2009-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20040008681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical