Basic Information
| Provider Information | |||||||||
| NPI: | 1407992282 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LILLARD | ||||||||
| FirstName: | SANDRA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1300 E BRADFORD PKWY | ||||||||
| Address2: | |||||||||
| City: | SPRINGFIELD | ||||||||
| State: | MO | ||||||||
| PostalCode: | 658044264 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4172695400 | ||||||||
| FaxNumber: | 4172697212 | ||||||||
| Practice Location | |||||||||
| Address1: | 3211 S PROVIDENCE RD | ||||||||
| Address2: | BUILDING C | ||||||||
| City: | COLUMBIA | ||||||||
| State: | MO | ||||||||
| PostalCode: | 652033639 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5738828008 | ||||||||
| FaxNumber: | 5738842001 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/29/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 005441 | MO | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.