Healthcare Provider Details

I. General information

NPI: 1952248478
Provider Name (Legal Business Name): AMANDA LADD
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2026
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 MUNICIPAL DR STE D
ARNOLD MO
63010-1043
US

IV. Provider business mailing address

2909 INDEPENDENCE ST
CAPE GIRARDEAU MO
63703-5044
US

V. Phone/Fax

Practice location:
  • Phone: 636-333-2641
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: