Individual provider Active NPI

Stephanie Clubb, LCSW

  • Clinical Social Worker
  • Saint Louis, MO
National Provider Identifier
1194264200
Registry record updated Jun 20, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
2015024020 Issued in MO
Practice address
5400 Devonshire Ave
Saint Louis, MO 63109-2841
Phone
(314) 384-6796
NPI assigned
Feb 22, 2017
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 20, 2026

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 2015024020 MO Primary

Addresses

Primary practice location

5400 Devonshire Ave
Saint Louis, MO 63109-2841

Mailing address

5400 Devonshire Ave
Saint Louis, MO 63109-2841
Phone (314) 384-6796

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20241231001459 MO Practitioner - Clinical Social Worker 0446787584 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
149018328ILMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Side by Side Wellness LLC Clinical CurrentSince Dec 16, 2024 Accepting new patients

Locations

1100 Rock Creek Elementary School Dr
O Fallon, MO 63366
Phone (636) 294-5787

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1487721600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1781913600000",
    "number": "1194264200",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5400 DEVONSHIRE AVE",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631092841",
            "telephone_number": "314-384-6796"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5400 DEVONSHIRE AVE",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631092841",
            "telephone_number": "314-384-6796"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLUBB",
        "first_name": "STEPHANIE",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-02-22",
        "last_updated": "2026-06-20",
        "certification_date": "2026-06-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MO",
            "license": "2015024020",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Louis, MO

Sources for this page

Verify at the official NPI Registry.