Healthcare Provider Details

I. General information

NPI: 1386312635
Provider Name (Legal Business Name): SHIAN VONHOLTEN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2021
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1212 W LOMBARD ST
SPRINGFIELD MO
65806-2720
US

IV. Provider business mailing address

4537 E STATE HIGHWAY KK
FAIR GROVE MO
65648-7832
US

V. Phone/Fax

Practice location:
  • Phone: 844-424-3577
  • Fax:
Mailing address:
  • Phone: 417-664-1729
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number2023049153
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: