Individual provider Active NPI

Rebecca Draper-Stuck, LCSW

  • Clinical Social Worker
  • Saint Joseph, MO
National Provider Identifier
1003883000
Registry record updated Jun 19, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
005563 Issued in MO
Practice address
2303 Village Dr
Saint Joseph, MO 64506-4954
Phone
(816) 232-4417
Fax
(816) 671-0961
NPI assigned
Mar 8, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 19, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 005563 MO Primary

Addresses

Primary practice location

2303 Village Dr
Saint Joseph, MO 64506-4954

Mailing address

2303 Village Dr
Saint Joseph, MO 64506-4954
Phone (816) 232-4417

Other identifiers 2

IdentifierTypeStateIssuer
494686215MedicaidMO
100288780DMedicaidKS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
005563MOMDClinical Social Worker

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1141776000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1245369600000",
    "number": "1003883000",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2303 VILLAGE DR",
            "city": "SAINT JOSEPH",
            "state": "MO",
            "postal_code": "645064954",
            "telephone_number": "816-232-4417",
            "fax_number": "816-671-0961"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2303 VILLAGE DR",
            "city": "SAINT JOSEPH",
            "state": "MO",
            "postal_code": "645064954",
            "telephone_number": "816-232-4417",
            "fax_number": "816-671-0961"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DRAPER-STUCK",
        "first_name": "REBECCA",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-03-08",
        "last_updated": "2009-06-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MO",
            "license": "005563",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "494686215",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100288780D",
            "state": "KS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Joseph, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.