Provider Demographics
NPI:1750756920
Name:WHITAKER, LAUREN (LMSW)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:WHITAKER
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:
Other - Last Name:OWEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:900 E LAHARPE ST
Mailing Address - Street 2:
Mailing Address - City:KIRKSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63501-4520
Mailing Address - Country:US
Mailing Address - Phone:660-665-1962
Mailing Address - Fax:660-665-3989
Practice Address - Street 1:10024 OFFICE CENTER AVE
Practice Address - Street 2:STE 100
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128-1381
Practice Address - Country:US
Practice Address - Phone:314-720-7050
Practice Address - Fax:314-729-0920
Is Sole Proprietor?:No
Enumeration Date:2015-12-14
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN20120314351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical