Healthcare Provider Details

I. General information

NPI: 1407215783
Provider Name (Legal Business Name): DARIN DUNN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/16/2016
Last Update Date: 02/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1212 W LOMBARD ST
SPRINGFIELD MO
65806-2720
US

IV. Provider business mailing address

1212 W LOMBARD ST
SPRINGFIELD MO
65806-2720
US

V. Phone/Fax

Practice location:
  • Phone: 417-865-1646
  • Fax:
Mailing address:
  • Phone: 417-865-1646
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW003442
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: