Healthcare Provider Details

I. General information

NPI: 1437898954
Provider Name (Legal Business Name): BAILEE REBEKAH WINTERROWD LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2022
Last Update Date: 06/02/2022
Certification Date: 06/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 CLARK AVE
LEBANON MO
65536-2331
US

IV. Provider business mailing address

1200 CLARK AVE
LEBANON MO
65536-2331
US

V. Phone/Fax

Practice location:
  • Phone: 417-650-6094
  • Fax:
Mailing address:
  • Phone: 417-650-6094
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number2022014070
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: