Provider Demographics
NPI:1841666997
Name:HEWITT, ADAM
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:
Last Name:HEWITT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1107 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:LAMAR
Mailing Address - State:MO
Mailing Address - Zip Code:64759-1758
Mailing Address - Country:US
Mailing Address - Phone:417-682-5757
Mailing Address - Fax:417-682-5757
Practice Address - Street 1:1107 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:LAMAR
Practice Address - State:MO
Practice Address - Zip Code:64759-1758
Practice Address - Country:US
Practice Address - Phone:417-682-5757
Practice Address - Fax:417-682-5757
Is Sole Proprietor?:No
Enumeration Date:2015-08-12
Last Update Date:2015-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20150241671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical