Healthcare Provider Details

I. General information

NPI: 1487294203
Provider Name (Legal Business Name): LEANNA APRIL FOWLDS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2020
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7412 BODE FERRY RD
JEFFERSON CITY MO
65101-7600
US

IV. Provider business mailing address

7412 BODE FERRY RD
JEFFERSON CITY MO
65101-7600
US

V. Phone/Fax

Practice location:
  • Phone: 573-469-2433
  • Fax: 573-550-2436
Mailing address:
  • Phone: 573-469-2433
  • Fax: 573-550-2436

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2021031414
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: