Provider Demographics
NPI:1780967208
Name:DUCKWORTH, MARGARET JANE (LCSW)
Entity type:Individual
Prefix:MS
First Name:MARGARET
Middle Name:JANE
Last Name:DUCKWORTH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MARGARET
Other - Middle Name:JANE
Other - Last Name:CHOATE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2465 E MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-4506
Mailing Address - Country:US
Mailing Address - Phone:417-689-3974
Mailing Address - Fax:
Practice Address - Street 1:440 E TAMPA ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65806
Practice Address - Country:US
Practice Address - Phone:417-831-0150
Practice Address - Fax:417-865-3479
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-21
Last Update Date:2018-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20110293691041C0700X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2011029369OtherMISSOURI STATE LICENSE