Healthcare Provider Details

I. General information

NPI: 1821531419
Provider Name (Legal Business Name): LEAH JAN DONNELSON LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/30/2016
Last Update Date: 03/27/2025
Certification Date: 03/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1147 E WALNUT ST
SPRINGFIELD MO
65806-2616
US

IV. Provider business mailing address

1147 E WALNUT ST
SPRINGFIELD MO
65806-2616
US

V. Phone/Fax

Practice location:
  • Phone: 417-425-0198
  • Fax:
Mailing address:
  • Phone: 417-425-0198
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2021015473
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: