Provider Demographics
NPI:1972362630
Name:DRY, WILLIAM CHARLES DAVID (MSW, LMSW)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:CHARLES DAVID
Last Name:DRY
Suffix:
Gender:M
Credentials:MSW, LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:614 SOUTH AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65806-3110
Mailing Address - Country:US
Mailing Address - Phone:417-896-9011
Mailing Address - Fax:417-889-6307
Practice Address - Street 1:614 SOUTH AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65806-3110
Practice Address - Country:US
Practice Address - Phone:417-896-9011
Practice Address - Fax:417-889-6307
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-15
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2023040266104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker