MEDICARE: AMBRIA MICHELLE WIMSATT LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	05541	KS
2	1041C0700X	Clinical Social Worker	2021005784	MO
3	104100000X	Social Worker	2018025722	MO

General Provider Information

NPI Number	:	1073086955
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMBRIA MICHELLE WIMSATT LCSW

Provider Business Mailing Address
First Line	:	825 S BUSINESS HIGHWAY 13
Second Line	:
City	:	LEXINGTON
State	:	MO
Zip	:	64067-1515
Country	:	US
Telephone Number	:	660-259-2440
Fax Number	:

Provider Business Practice Location Address
First Line	:	608 MISSOURI ST
Second Line	:
City	:	WAVERLY
State	:	MO
Zip	:	64096-8241
Country	:	US
Telephone Number	:	877-344-3572
Fax Number	:	866-288-4492

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/03/2019
Last Update Date	:	11/10/2025

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