Healthcare Provider Details

I. General information

NPI: 1891308599
Provider Name (Legal Business Name): KACEE D WEAVER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KACEE D CAGLE LCSW

II. Dates (important events)

Enumeration Date: 08/24/2020
Last Update Date: 06/17/2025
Certification Date: 06/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 KELLEY PKWY
MEXICO MO
65265-3811
US

IV. Provider business mailing address

340 KELLEY PKWY
MEXICO MO
65265-3811
US

V. Phone/Fax

Practice location:
  • Phone: 573-582-1234
  • Fax: 573-582-1212
Mailing address:
  • Phone: 573-582-1234
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2022044287
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: