Individual
RENEE C STUCKY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
1100 VIRGINIA AVE, COLUMBIA, MO 65212-0001
(573) 882-2663
(573) 882-1760
Mailing address
PO BOX 843966, KANSAS CITY, MO 64184-3966
(573) 884-3300
(573) 884-0943
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
R0520
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
493997209
—
MO
01
—
680011196
RR MEDICARE
MO
Enumeration date
06/01/2006
Last updated
07/02/2024
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