Healthcare Provider Details

I. General information

NPI: 1841326469
Provider Name (Legal Business Name): JANET K HULTGREN MSW LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

#2 MELGROVE STE 204
HANNIBAL MO
63401
US

IV. Provider business mailing address

#2 MELGROVE STE 204
HANNIBAL MO
63401
US

V. Phone/Fax

Practice location:
  • Phone: 573-221-0102
  • Fax: 573-221-0102
Mailing address:
  • Phone: 573-221-0102
  • Fax: 573-221-0102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSW001291
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: