MEDICARE: MR. QUINTIN E EWING MSW, 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	2004027762	MO

General Provider Information

NPI Number	:	1346532116
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. QUINTIN E EWING MSW, LCSW

Provider Business Mailing Address
First Line	:	1300 E BRADFORD PKWY
Second Line	:
City	:	SPRINGFIELD
State	:	MO
Zip	:	65804-4264
Country	:	US
Telephone Number	:	417-761-5000
Fax Number	:	417-761-5111

Provider Business Practice Location Address
First Line	:	1300 E BRADFORD PKWY
Second Line	:
City	:	SPRINGFIELD
State	:	MO
Zip	:	65804-4264
Country	:	US
Telephone Number	:	417-761-5000
Fax Number	:	417-761-5111

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

Provider Enumeration Date	:	05/11/2011
Last Update Date	:	02/05/2026

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