Healthcare Provider Details

I. General information

NPI: 1972111912
Provider Name (Legal Business Name): HEATHER RENEE THOMAS LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2020
Last Update Date: 03/18/2025
Certification Date: 03/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122 RANGER DR
MARSHFIELD MO
65706-9612
US

IV. Provider business mailing address

122 RANGER DR
MARSHFIELD MO
65706-9612
US

V. Phone/Fax

Practice location:
  • Phone: 417-761-1237
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2022045758
License Number StateMO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: