Healthcare Provider Details

I. General information

NPI: 1629078340
Provider Name (Legal Business Name): ALKA ANNE MCINTOSH LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3407 BERRYWOOD DR SUITE 200
COLUMBIA MO
65201-6500
US

IV. Provider business mailing address

3407 BERRYWOOD DR SUITE 200
COLUMBIA MO
65201-6500
US

V. Phone/Fax

Practice location:
  • Phone: 573-443-1177
  • Fax: 573-499-1564
Mailing address:
  • Phone: 573-443-1177
  • Fax: 573-499-1564

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSW002402
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: