Provider Demographics
NPI:1841326469
Name:HULTGREN, JANET K (MSW LCSW)
Entity type:Individual
Prefix:
First Name:JANET
Middle Name:K
Last Name:HULTGREN
Suffix:
Gender:F
Credentials:MSW LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:#2 MELGROVE STE 204
Mailing Address - Street 2:
Mailing Address - City:HANNIBAL
Mailing Address - State:MO
Mailing Address - Zip Code:63401
Mailing Address - Country:US
Mailing Address - Phone:573-221-0102
Mailing Address - Fax:573-221-0102
Practice Address - Street 1:#2 MELGROVE STE 204
Practice Address - Street 2:
Practice Address - City:HANNIBAL
Practice Address - State:MO
Practice Address - Zip Code:63401
Practice Address - Country:US
Practice Address - Phone:573-221-0102
Practice Address - Fax:573-221-0102
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOSW001291104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
107918OtherVALUE OPTIONS
177544OtherBLUE CROSS BLUE S
107918OtherVALUE OPTIONS