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General NPI Number Information
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NPI Number | 1063941839
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Entity Type | Individual
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Provider Name | LAVEEDA C SIMMONS MSW
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Gender | Female
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Dates
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Enumeration Date | 06/06/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 20509 S STATE ROUTE J
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City | PECULIAR
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State | MO
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Zip | 64078-9414
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Country | US
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Telephone | 816-779-5173
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Fax | 816-758-5112
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Provider Business Mailing Address
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Address Line | PO BOX 447
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City | PECULIAR
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State | MO
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Zip | 64078-0447
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Country | US
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Telephone | 816-779-5173
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Fax | 816-758-5112
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 2016035595
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License Number State | MO
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