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General NPI Number Information
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NPI Number | 1730457300
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Entity Type | Individual
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Provider Name | JACINDA REA LCSW
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Gender | Female
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Dates
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Enumeration Date | 12/09/2011
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Last Update Date | 07/07/2025
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Provider Practice Location Address
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Address Line | 203 2ND AVE SW
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City | MIAMI
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State | OK
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Zip | 74354-6818
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Country | US
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Telephone | 417-214-6648
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Fax |
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Provider Business Mailing Address
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Address Line | 406 E 3RD TER
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City | LAMAR
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State | MO
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Zip | 64759-1150
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Country | US
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Telephone | 417-214-6648
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Fax |
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 2016029485
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 5174
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License Number State | OK
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