| Doctor Name: | MRS. KELLY RAE STADDIE |
| NPI Number: | 1093879835 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LCSW |
| License Number: | 2005008356 |
| Business Practice Address: | 734 W Monroe St Mexico, MO - 652651970 |
| Business Phone Number: | 5736425345 |
| Business Fax Number: | 5736425162 |
| Mailing Address: | 24 Lakeside Pl, MEXICO |
| State: | MO |
| Postal Code: | 652652227 |
| Phone Number: | 5735827866 |
| Fax Number: | |
| NPI Enumeration Date: | 12/19/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | 2005008356 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MO |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |