Healthcare Provider Details

I. General information

NPI: 1508585480
Provider Name (Legal Business Name): SYDNEY KATHERINE VANDEGRIFT LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2022
Last Update Date: 04/09/2026
Certification Date: 04/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3506 S CULPEPPER CIR STE D
SPRINGFIELD MO
65804-4251
US

IV. Provider business mailing address

PO BOX 68
WALNUT GROVE MO
65770-0068
US

V. Phone/Fax

Practice location:
  • Phone: 417-210-1470
  • Fax:
Mailing address:
  • Phone: 573-418-9613
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2025007094
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: