Healthcare Provider Details

I. General information

NPI: 1396389466
Provider Name (Legal Business Name): ABBY LEAH CHILTON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2019
Last Update Date: 11/27/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14547 S 3025 RD
EL DORADO SPRINGS MO
64744-7114
US

IV. Provider business mailing address

14547 S 3025 RD
EL DORADO SPRINGS MO
64744-7114
US

V. Phone/Fax

Practice location:
  • Phone: 417-684-4400
  • Fax:
Mailing address:
  • Phone: 417-684-4400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2019009213
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: