Elizabeth Anne Derickson, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

2012003258 Issued in MO

Practice address

181 Lallybroch CT
Jackson, MO 63755-4145

Phone

(573) 837-0928

NPI assigned

Sep 24, 2010

Last updated

Dec 2, 2025By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 4

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Youth Substance Abuse Coalition

  dba Epic

  • Mental Health Counselor
  • Cape Girardeau, MO
  • NPI 1194452946

  Clinical

  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1285286400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1764633600000",
    "number": "1043528052",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "181 LALLYBROCH CT",
            "city": "JACKSON",
            "state": "MO",
            "postal_code": "637554145",
            "telephone_number": "573-837-0928"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "181 LALLYBROCH CT",
            "city": "JACKSON",
            "state": "MO",
            "postal_code": "637554145",
            "telephone_number": "573-837-0928"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DERICKSON",
        "first_name": "ELIZABETH",
        "middle_name": "ANNE",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-09-24",
        "last_updated": "2025-12-02",
        "certification_date": "2025-12-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "MO",
            "license": "2010013148",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MO",
            "license": "2012003258",
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "WA",
            "license": "LW61133188",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IN",
            "license": "34007903A",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Melissa Cruts
• Rachael Daume, APRN, AGPCNP-BC
• Donald Richard Davis Jr., DC
• Kacey Ann Davis, BS,CD, SBD, CLC, CPS
• Kelly Alane Declerk, PHARMD
• Kenneth Charles Detring, O.D.
• Amy Diamond, BCBA
• DME Devices Co., LLC
• Alyssa Donaldson
• Emily Nicole Dorris, LPC, NCC

• Clinical Social Worker in Jackson, MO
• Providers in Jackson, MO by specialty
• Clinical Social Worker in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.