Provider Demographics
NPI:1124044961
Name:NAEGER, STELLA M
Entity type:Individual
Prefix:
First Name:STELLA
Middle Name:M
Last Name:NAEGER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:STELLA
Other - Middle Name:M
Other - Last Name:ROTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:16253 STATE ROUTE B
Mailing Address - Street 2:
Mailing Address - City:SAINTE GENEVIEVE
Mailing Address - State:MO
Mailing Address - Zip Code:63670-9143
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:301 N WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:MO
Practice Address - Zip Code:63640-1751
Practice Address - Country:US
Practice Address - Phone:573-756-6101
Practice Address - Fax:573-756-6420
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO001128101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor