Basic Information
| Provider Information | |||||||||
| NPI: | 1477506020 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BUONAURA | ||||||||
| FirstName: | STACIE | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | MSW, LCSW, CRAADC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1500 N WESTWOOD BLVD | ||||||||
| Address2: | |||||||||
| City: | POPLAR BLUFF | ||||||||
| State: | MO | ||||||||
| PostalCode: | 639013318 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5736864151 | ||||||||
| FaxNumber: | 5737784156 | ||||||||
| Practice Location | |||||||||
| Address1: | 1500 N WESTWOOD BLVD | ||||||||
| Address2: | |||||||||
| City: | POPLAR BLUFF | ||||||||
| State: | MO | ||||||||
| PostalCode: | 639013318 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5736864151 | ||||||||
| FaxNumber: | 5737784156 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/17/2006 | ||||||||
| LastUpdateDate: | 04/18/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 2006006713 | MO | N | Behavioral Health & Social Service Providers | Social Worker | 1041C0700X | 2006006713 | MO | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | HEALTHLINK FREEDOM | 01 | 552122 | OTHER | 2794 | 01 | EAP IMPACT | OTHER | 11627576 | 01 | CAQH | OTHER | 431823864 | 01 | CORPHEALTH | OTHER | 552122 | 01 | FORTIS/HEALTHLINK | OTHER | 490255502 | 05 | MO | MEDICAID | 552122 | 01 | HELATHLINK PPO | OTHER | 552122 | 01 | EPOCH | OTHER | 431116734 | 01 | EAP INTERFACE | OTHER | 431116734 | 01 | EAP CERIDIAN | OTHER |