Provider Demographics
NPI:1174884654
Name:GODFREY, BOBBI MICHELE (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:BOBBI
Middle Name:MICHELE
Last Name:GODFREY
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:BOBBI
Other - Middle Name:
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2885 W BATTLEFIELD ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65807-3952
Mailing Address - Country:US
Mailing Address - Phone:417-761-5000
Mailing Address - Fax:417-761-5011
Practice Address - Street 1:17611 E US HIGHWAY 24
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64056-1853
Practice Address - Country:US
Practice Address - Phone:816-836-6350
Practice Address - Fax:816-886-5000
Is Sole Proprietor?:No
Enumeration Date:2012-05-31
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR9070-M104100000X
MO20220273001041C0700X
AR9070M1041C0700X
MO20220406051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR192122795Medicaid