Healthcare Provider Details

I. General information

NPI: 1205763588
Provider Name (Legal Business Name): KENDALL MARGARET DEWEIN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2026
Last Update Date: 05/08/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

409 VANDIVER DR BLDG 4
COLUMBIA MO
65202-3754
US

IV. Provider business mailing address

409 VANDIVER DR BLDG 4
COLUMBIA MO
65202-3754
US

V. Phone/Fax

Practice location:
  • Phone: 573-825-3455
  • Fax: 573-875-0371
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2025033920
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: