Individual
JENNIFER VANDIVORT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4647 E HIDDEN OAK PL, SPRINGFIELD, MO 65802-7529
(573) 356-8015
Mailing address
4647 E HIDDEN OAK PL, SPRINGFIELD, MO 65802-7529
(573) 356-8015
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
20150263379
MO
Other
Enumeration date
01/05/2022
Last updated
01/05/2022
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