Healthcare Provider Details

I. General information

NPI: 1669307674
Provider Name (Legal Business Name): AMANDA JO KIRK LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2026
Last Update Date: 06/13/2026
Certification Date: 06/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6615 CLEMENS AVE APT 1W
UNIVERSITY CITY MO
63130-3208
US

IV. Provider business mailing address

6615 CLEMENS AVE APT 1W
UNIVERSITY CITY MO
63130-3208
US

V. Phone/Fax

Practice location:
  • Phone: 407-973-0355
  • Fax:
Mailing address:
  • Phone: 407-973-0355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2026001094
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: