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NPI Code Detail

MEDICARE: AMANDA JO KIRK LCSW

MEDICARE: AMANDA JO KIRK LCSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker2026001094MO

General Provider Information

NPI Number : 1669307674
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMANDA JO KIRK LCSW
Provider Business Mailing Address
First Line : 6615 CLEMENS AVE APT 1W
Second Line :
City : UNIVERSITY CITY
State : MO
Zip : 63130-3208
Country : US
Telephone Number : 407-973-0355
Fax Number :
Provider Business Practice Location Address
First Line : 6615 CLEMENS AVE APT 1W
Second Line :
City : UNIVERSITY CITY
State : MO
Zip : 63130-3208
Country : US
Telephone Number : 407-973-0355
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/13/2026
Last Update Date : 06/13/2026

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