Individual
ANGELICA GRACE FORTENBERRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSW, LCSW
Contact information
Practice address
17844 E 23RD ST S, INDEPENDENCE, MO 64057-1840
(816) 254-3652
Mailing address
PO BOX 260, INDEPENDENCE, MO 64051-0260
(816) 254-3652
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
2024000988
MO
Other
Enumeration date
11/17/2021
Last updated
01/05/2026
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