Healthcare Provider Details

I. General information

NPI: 1538363486
Provider Name (Legal Business Name): LACLEDE ASSOCIATION FOR DEVELOPMENTAL DISABILITIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2007
Last Update Date: 05/26/2023
Certification Date: 05/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 LAWSON AVE.
LEBANON MO
65536
US

IV. Provider business mailing address

200 LAWSON AVE.
LEBANON MO
65536
US

V. Phone/Fax

Practice location:
  • Phone: 417-588-1577
  • Fax:
Mailing address:
  • Phone: 417-588-1577
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number605
License Number StateMO

VIII. Authorized Official

Name: KATY CLANTON
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 417-588-1577