Healthcare Provider Details

I. General information

NPI: 1780521831
Provider Name (Legal Business Name): HEATHER NICOLE VISSER LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2026
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1636 S GLENSTONE AVE
SPRINGFIELD MO
65804-1506
US

IV. Provider business mailing address

1252 CAP HILL RANCH RD
OZARK MO
65721-6148
US

V. Phone/Fax

Practice location:
  • Phone: 417-881-1900
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number2024030692
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: