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Provider Information for 1679037352


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AMANDA LEFTRIDGE MSW, LMSW


Sex: Female

NPI: 1679037352
Last Updated: 2019-01-26
Certification Date:

Details

NameValue
NPI1679037352
Enumeration Date2019-01-26
NPI TypeNPI-1 Individual
Sole ProprietorNO
StatusActive
Mailing Address 400 N WASHINGTON ST STE 229
FARMINGTON, MO 63640-1716
United States

Phone: 573-218-9653 | Fax:573-803-1405
 
Primary Practice Address 400 N WASHINGTON ST STE 229
FARMINGTON, MO 63640-1716
United States

Phone: 573-218-9653 | Fax:573-803-1405
 
Secondary Practice Address(es)
Health Information Exchange
Endpoint TypeEndpointEndpoint DescriptionUseContent TypeAffiliationEndpoint Location
Other Identifiers
IssuerStateNumberOther Issuer
Taxonomy
Primary TaxonomySelected TaxonomyStateLicense Number
Yes 104100000X - Social Worker MO2019002280