Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 2016040022 | MO |
NPI | 1003342783 |
---|---|
Provider Name | Stacey Samantha Soliman Juilfs |
First Address | Saint Charles, MO 63303-4120 |
Second Address | Quincy, IL 62301-3919 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/05/2017 |
Last Update Date | 04/06/2021 |