Healthcare Provider Details

I. General information

NPI: 1043353089
Provider Name (Legal Business Name): SAMANTHA JO BRANNEN MSW, PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/15/2007
Last Update Date: 03/27/2026
Certification Date: 03/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

449 WYMAN DR
WOOD HEIGHTS MO
64024-2803
US

IV. Provider business mailing address

449 WYMAN DR
WOOD HEIGHTS MO
64024-2803
US

V. Phone/Fax

Practice location:
  • Phone: 816-317-4120
  • Fax: 816-479-2203
Mailing address:
  • Phone: 816-317-4120
  • Fax: 816-479-2203

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2002026474
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: