Individual
JENNIFER L GANAWAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSW, LCSW
Contact information
Practice address
1300 E BRADFORD PKWY, SPRINGFIELD, MO 65804-4264
(417) 761-5000
Mailing address
1300 E BRADFORD PKWY, SPRINGFIELD, MO 65804-4264
(417) 761-5000
(417) 761-5011
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
2017031323
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
490022150
—
MO
Enumeration date
05/27/2015
Last updated
01/15/2020
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