Individual
STEPHANIE RUBECCA WOOTEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1465 S GRAND BLVD RM 2717, SAINT LOUIS, MO 63104-1003
(314) 577-5634
(314) 577-5616
Mailing address
1465 S GRAND BLVD RM 2717, SAINT LOUIS, MO 63104-1003
(314) 577-5634
(314) 577-5616
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
2023019634
MO
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
03/23/2023
Last updated
04/02/2026
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