Healthcare Provider Details

I. General information

NPI: 1639033160
Provider Name (Legal Business Name): CHRISTY ROJANA WYMAN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/10/2025
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 S LOCUST ST
DEXTER MO
63841-2148
US

IV. Provider business mailing address

11642 FINLEY DR
DEXTER MO
63841-9326
US

V. Phone/Fax

Practice location:
  • Phone: 573-283-8955
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2025050086
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: