Provider Demographics
NPI:1871663161
Name:CHENOWETH, AMELIA (MS)
Entity Type:Individual
Prefix:MRS
First Name:AMELIA
Middle Name:
Last Name:CHENOWETH
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2155 E BERKELEY ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-3336
Mailing Address - Country:US
Mailing Address - Phone:417-860-8684
Mailing Address - Fax:
Practice Address - Street 1:2021 S WAVERLY AVE STE 700
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-2400
Practice Address - Country:US
Practice Address - Phone:417-860-8684
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2011-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOCS001233101YP2500X
MO0031844101YS0200X
MOSW0035631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO493520852Medicaid
MO493520837Medicaid
MO493520852Medicaid