Individual
ELIZABETH ANNE DERICKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
181 LALLYBROCH CT, JACKSON, MO 63755-4145
(573) 837-0928
Mailing address
181 LALLYBROCH CT, JACKSON, MO 63755-4145
(573) 837-0928
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
2010013148
MO
1041C0700X
Clinical Social Worker
Primary
2012003258
MO
1041C0700X
Clinical Social Worker
34007903A
IN
1041C0700X
Clinical Social Worker
LW61133188
WA
Other
Enumeration date
09/24/2010
Last updated
12/02/2025
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