Healthcare Provider Details

I. General information

NPI: 1669642906
Provider Name (Legal Business Name): GLENDA E PITTMAN MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2008
Last Update Date: 03/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1180 HWY WW
MARSHALL MO
65340
US

IV. Provider business mailing address

1180 HWY WW P.O. BOX 333
MARSHALL MI
65340
US

V. Phone/Fax

Practice location:
  • Phone: 660-886-2253
  • Fax:
Mailing address:
  • Phone: 660-886-2253
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number005344
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: