Individual
ELLEN L LEVINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
1300 E BRADFORD PKWY, SPRINGFIELD, MO 65804-4264
(417) 761-5000
Mailing address
PO BOX 844715, KANSAS CITY, MO 64184-4715
(417) 761-5214
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
2011029059
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2011029059
LCSW
MO
Enumeration date
01/09/2017
Last updated
11/11/2024
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