Individual
LINDA VANDIVERT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
20552 W 340TH ST, BETHANY, MO 64424-8335
(660) 425-5522
Mailing address
20552 W 340TH ST, BETHANY, MO 64424-8335
(660) 425-5522
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Enumeration date
02/16/2019
Last updated
12/06/2019
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