Healthcare Provider Details

I. General information

NPI: 1235857772
Provider Name (Legal Business Name): LAUREN GRAVES KROPF LSWC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2022
Last Update Date: 04/24/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1306 N SMILEY ST
O FALLON IL
62269-6760
US

IV. Provider business mailing address

1306 N SMILEY ST
O FALLON IL
62269-6760
US

V. Phone/Fax

Practice location:
  • Phone: 701-340-8889
  • Fax:
Mailing address:
  • Phone: 701-340-8889
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberBBH-SWLC-LIC-55865
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: