Provider Demographics
NPI:1194497206
Name:DANCER, JODI LYNNE (LCSW)
Entity type:Individual
Prefix:
First Name:JODI
Middle Name:LYNNE
Last Name:DANCER
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 1:2916 US HIGHWAY 63
Mailing Address - Street 2:
Mailing Address - City:WILLOW SPRINGS
Mailing Address - State:MO
Mailing Address - Zip Code:65793-9289
Mailing Address - Country:US
Mailing Address - Phone:417-616-3039
Mailing Address - Fax:
Practice Address - Street 1:1211 PORTER WAGONER BLVD
Practice Address - Street 2:
Practice Address - City:WEST PLAINS
Practice Address - State:MO
Practice Address - Zip Code:65775-1826
Practice Address - Country:US
Practice Address - Phone:417-257-6762
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-28
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
MO2022000964104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker