Provider Demographics
NPI:1841510930
Name:SMALLWOOD, JANESE DIANNE (LCSW)
Entity type:Individual
Prefix:
First Name:JANESE
Middle Name:DIANNE
Last Name:SMALLWOOD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:88 SE 461ST RD
Mailing Address - Street 2:
Mailing Address - City:WARRENSBURG
Mailing Address - State:MO
Mailing Address - Zip Code:64093-7956
Mailing Address - Country:US
Mailing Address - Phone:641-660-3801
Mailing Address - Fax:
Practice Address - Street 1:1031 VANDENBERG AVE
Practice Address - Street 2:
Practice Address - City:WHITEMAN AFB
Practice Address - State:MO
Practice Address - Zip Code:65305-5100
Practice Address - Country:US
Practice Address - Phone:641-660-3801
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-11
Last Update Date:2025-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCSW099237941041C0700X
AZLCSW-185261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical