Healthcare Provider Details

I. General information

NPI: 1013791086
Provider Name (Legal Business Name): RAVEN A TRANBARGER LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2023
Last Update Date: 08/25/2025
Certification Date: 08/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1628 OKLAHOMA AVE
TRENTON MO
64683-2565
US

IV. Provider business mailing address

PO BOX 30
TRENTON MO
64683-0030
US

V. Phone/Fax

Practice location:
  • Phone: 660-359-4600
  • Fax:
Mailing address:
  • Phone: 660-359-4487
  • Fax: 660-359-2958

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number2023023933
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: