Healthcare Provider Details

I. General information

NPI: 1154731958
Provider Name (Legal Business Name): LESLIE SMITH LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LESLIE ROBISON LCSW

II. Dates (important events)

Enumeration Date: 05/01/2014
Last Update Date: 01/04/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1906 S LANCASTER AVE
SPRINGFIELD MO
65807-2429
US

IV. Provider business mailing address

1906 S LANCASTER AVE
SPRINGFIELD MO
65807-2429
US

V. Phone/Fax

Practice location:
  • Phone: 417-459-7247
  • Fax:
Mailing address:
  • Phone: 417-459-7247
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2014009397
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: