Provider Demographics
NPI:1457604704
Name:KNOX, STACI M (LCSW)
Entity Type:Individual
Prefix:
First Name:STACI
Middle Name:M
Last Name:KNOX
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:STACI
Other - Middle Name:M
Other - Last Name:SPENCER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:414 RIGGIN RD
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:IL
Mailing Address - Zip Code:62294-1023
Mailing Address - Country:US
Mailing Address - Phone:618-974-2291
Mailing Address - Fax:
Practice Address - Street 1:815 E 5TH ST
Practice Address - Street 2:SUITE 101
Practice Address - City:ALTON
Practice Address - State:IL
Practice Address - Zip Code:62002-6471
Practice Address - Country:US
Practice Address - Phone:618-974-2291
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-24
Last Update Date:2016-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490170341041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical