Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker |
NPI | 1003271024 |
---|---|
Provider Name | Ms. Stephanie Kippenberger |
First Address | Saint Louis, MO 63108-1812 |
Second Address | Saint Louis, MO 63108-1812 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/12/2015 |
Last Update Date | 17/12/2015 |