Healthcare Provider Details

I. General information

NPI: 1063941839
Provider Name (Legal Business Name): LAVEEDA C SIMMONS MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20509 S STATE ROUTE J
PECULIAR MO
64078-9414
US

IV. Provider business mailing address

PO BOX 447
PECULIAR MO
64078-0447
US

V. Phone/Fax

Practice location:
  • Phone: 816-779-5173
  • Fax: 816-758-5112
Mailing address:
  • Phone: 816-779-5173
  • Fax: 816-758-5112

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number2016035595
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: