Provider Demographics
NPI:1427248178
Name:KILE, STACY NICOLE (MS, MA, CCCSLP, PLPC)
Entity type:Individual
Prefix:MRS
First Name:STACY
Middle Name:NICOLE
Last Name:KILE
Suffix:
Gender:F
Credentials:MS, MA, CCCSLP, PLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 JACKS CABIN DR
Mailing Address - Street 2:
Mailing Address - City:DEFIANCE
Mailing Address - State:MO
Mailing Address - Zip Code:63341-1329
Mailing Address - Country:US
Mailing Address - Phone:314-616-9609
Mailing Address - Fax:
Practice Address - Street 1:1715 DEER TRACKS TRL STE 260
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63131-1855
Practice Address - Country:US
Practice Address - Phone:314-616-9609
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-30
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
FLSZ4252235Z00000X
MO235Z00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty