Destiny Leeanne Pottebaum, MSW
Social Worker, Clinical in New Haven, MO. Individual provider (NPI-1).
NPI number1255032017
StatusActive
Last updated in NPPESMar 16, 2023
Details
- NPI
- 1255032017
- Entity type
- Individual (NPI-1)
- Name
- Destiny Leeanne Pottebaum
- Credential
- MSW
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Mar 16, 2023
- Certification date
- Mar 16, 2023
- Last updated
- Mar 16, 2023
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1041C0700X | Social Worker, Clinical | ISW16733 | FL | Yes |
Practice location
917 Miller StNew Haven, MO 63068-1192
Phone 636-357-0937
Mailing address
917 Miller StNew Haven, MO 63068-1192
Phone 636-357-0937
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