Individual
DESTINY LEEANNE POTTEBAUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSW
Contact information
Practice address
917 MILLER ST, NEW HAVEN, MO 63068-1192
(636) 357-0937
Mailing address
917 MILLER ST, NEW HAVEN, MO 63068-1192
(636) 357-0937
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
ISW16733
FL
Other
Enumeration date
03/16/2023
Last updated
03/16/2023
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