Healthcare Provider Details

I. General information

NPI: 1124523659
Provider Name (Legal Business Name): CINDY RENEE AUG LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2018
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

402 E WASHINGTON ST
JACKSON MO
63755-1451
US

IV. Provider business mailing address

PO BOX 172
JACKSON MO
63755-0172
US

V. Phone/Fax

Practice location:
  • Phone: 573-275-1508
  • Fax:
Mailing address:
  • Phone: 573-275-1508
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2016038352
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: