Healthcare Provider Details

I. General information

NPI: 1851528087
Provider Name (Legal Business Name): KRYSTAL L WITTHAUS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2009
Last Update Date: 05/01/2025
Certification Date: 05/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 BAVARIAN HILLS PLZ
HERMANN MO
65041-1613
US

IV. Provider business mailing address

PO BOX 19
HERMANN MO
65041-0019
US

V. Phone/Fax

Practice location:
  • Phone: 573-486-2118
  • Fax: 573-486-3533
Mailing address:
  • Phone: 573-486-1193
  • Fax: 573-486-0910

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2008028021
License Number StateMO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: