Provider Demographics
NPI:1568285906
Name:GUENGERICH, OLIVIA ARDEN (LMSW)
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:ARDEN
Last Name:GUENGERICH
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5844 S GERANIUM LN
Mailing Address - Street 2:
Mailing Address - City:BATTLEFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65619-8700
Mailing Address - Country:US
Mailing Address - Phone:573-692-0170
Mailing Address - Fax:
Practice Address - Street 1:3506 S CULPEPPER CIR STE D
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-4251
Practice Address - Country:US
Practice Address - Phone:417-893-9359
Practice Address - Fax:417-450-4896
Is Sole Proprietor?:No
Enumeration Date:2024-11-04
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2024030294104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker