Stacey Lynn Ederer

Primary specialty

Social WorkerTaxonomy code 104100000X

License

2010028186 Issued in MO

Practice address

6617 E Yorkshire Dr
Saint Louis, MO 63123-1521

Phone

(314) 402-4677

NPI assigned

Jan 31, 2022

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Stacey Lynn Cochran Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1643587200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1643587200000",
    "number": "1225781115",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6617 E YORKSHIRE DR",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631231521",
            "telephone_number": "314-402-4677"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6617 E YORKSHIRE DR",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631231521",
            "telephone_number": "314-402-4677"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EDERER",
        "first_name": "STACEY",
        "middle_name": "LYNN",
        "name_prefix": "Ms.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-01-31",
        "last_updated": "2022-01-31",
        "certification_date": "2022-01-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "MO",
            "license": "2010028186",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "STACEY",
            "last_name": "COCHRAN",
            "middle_name": "LYNN",
            "credential": "LCSW",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Brian Todd Edelson, M.D., PH.D.
• Sean Lewis Edelstein, MD
• Eden Manor LLC
• Eden Pediatrics LLC
• Edens Sacred Hand Homecare, LLC
• Julia D Edgar, MA
• Randall C Edgell, MD
• Tyler I Edgerton
• Edgewood Childrens Center
• Chris K Edler, CRNA

• Social Worker in Saint Louis, MO
• Providers in Saint Louis, MO by specialty
• Social Worker in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2022; 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.