Provider Demographics
NPI:1811324015
Name:SCHANDER, GWYNAVERE KRISTIN (LMSW)
Entity type:Individual
Prefix:MRS
First Name:GWYNAVERE
Middle Name:KRISTIN
Last Name:SCHANDER
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 1:2124 W CHESTERFIELD BLVD STE D102
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65807-8648
Mailing Address - Country:US
Mailing Address - Phone:417-862-2273
Mailing Address - Fax:
Practice Address - Street 1:2124 W CHESTERFIELD BLVD STE D102
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-8648
Practice Address - Country:US
Practice Address - Phone:417-862-2273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-02
Last Update Date:2014-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012013684104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker