Healthcare Provider Details

I. General information

NPI: 1154487767
Provider Name (Legal Business Name): JULIE PARTIN L.C.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1722 S GLENSTONE AVE STE H
SPRINGFIELD MO
65804-1513
US

IV. Provider business mailing address

1722 S GLENSTONE AVE STE H
SPRINGFIELD MO
65804-1513
US

V. Phone/Fax

Practice location:
  • Phone: 417-881-9518
  • Fax: 417-887-2051
Mailing address:
  • Phone: 417-881-9518
  • Fax: 417-887-2051

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2004020875
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: