Healthcare Provider Details

I. General information

NPI: 1841480944
Provider Name (Legal Business Name): DAWN ANNETTE SIMMERMAN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2007
Last Update Date: 10/18/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1610 E. SUNSHINE STREET
SPRINGFIELD MO
65804
US

IV. Provider business mailing address

1610 E. SUNSHINE STREET
SPRINGFIELD MO
65804
US

V. Phone/Fax

Practice location:
  • Phone: 417-523-7500
  • Fax: 417-523-7595
Mailing address:
  • Phone: 417-523-7500
  • Fax: 417-523-7595

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2005017800
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: