Provider Demographics
NPI:1740831619
Name:WIBBENMEYER, TONYA (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:TONYA
Middle Name:
Last Name:WIBBENMEYER
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5011 SCENIC VIEW ACRES DR
Mailing Address - Street 2:
Mailing Address - City:IMPERIAL
Mailing Address - State:MO
Mailing Address - Zip Code:63052-1554
Mailing Address - Country:US
Mailing Address - Phone:224-818-4257
Mailing Address - Fax:
Practice Address - Street 1:5011 SCENIC VIEW ACRES DR
Practice Address - Street 2:
Practice Address - City:IMPERIAL
Practice Address - State:MO
Practice Address - Zip Code:63052-1554
Practice Address - Country:US
Practice Address - Phone:224-818-4257
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-23
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20240160341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical