Individual
HEATHER AMANDA BLUMBERG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
117 N GARTH AVE, COLUMBIA, MO 65203-4103
(573) 449-2581
(573) 449-2583
Mailing address
117 N GARTH AVE, COLUMBIA, MO 65203-4103
(573) 449-2581
(573) 449-2583
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
2013031031
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2011008280
PROVISIONAL STATE LICENSE
MO
Enumeration date
07/27/2011
Last updated
09/05/2013
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