Healthcare Provider Details

I. General information

NPI: 1134336829
Provider Name (Legal Business Name): ANGELA SICELUFF LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5549 N HIGHWAY 13
BRIGHTON MO
65617-8112
US

IV. Provider business mailing address

PO BOX 617
BRIGHTON MO
65617-0617
US

V. Phone/Fax

Practice location:
  • Phone: 417-376-2238
  • Fax: 417-376-2014
Mailing address:
  • Phone: 417-376-2238
  • Fax: 417-376-2014

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number002401
License Number StateMO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: