Healthcare Provider Details

I. General information

NPI: 1316456841
Provider Name (Legal Business Name): AMANDA HENTE MSW, LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2909 INDEPENDENCE ST
CAPE GIRARDEAU MO
63703-5044
US

IV. Provider business mailing address

2909 INDEPENDENCE ST
CAPE GIRARDEAU MO
63703-5044
US

V. Phone/Fax

Practice location:
  • Phone: 573-803-1402
  • Fax: 573-803-1405
Mailing address:
  • Phone: 573-803-1402
  • Fax: 573-803-1405

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number2017008788
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: