Healthcare Provider Details

I. General information

NPI: 1669715942
Provider Name (Legal Business Name): RONI TOWNSEND LSCSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2013
Last Update Date: 10/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 WESTWOODS DRIVE
LIBERTY MO
64068
US

IV. Provider business mailing address

112 WESTWOODS DRIVE
LIBERTY MO
64068
US

V. Phone/Fax

Practice location:
  • Phone: 308-627-1785
  • Fax: 816-302-9939
Mailing address:
  • Phone: 308-627-1785
  • Fax: 816-302-9939

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number2017001740
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2017001740
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number4598
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: