Resource Directory Provider Update

Are you currently listed? Yes No

1. Demographic Information

Fields marked with an asterisk (*) are required.

Organization Name:
*
Address:
*
Address 2:

City:
*
State:
*
Zip:
*
Email:
*
Phone Number:
*
Toll Free Number:

TTY/TDD Number:

Video Phone Number:

Web Address:

2. Ages Served:*

Ages 0 - 18

Ages 18 and up

3. Please check the services that are provided by your agency:*

Advocacy Services

Adaptive Medical equipment (i.e. prosthetics, wheelchairs, etc)

Assistive Technology (i.e. assistive listening devices, communication devices, etc)

Behavioral therapies

Case Management Services

Day Services/Habilitation

Emergency Preparedness

Employment Resources

Educational Resources

Healthcare

Home Modifications/Universal Design

Housing assistance

Independent living Skills training

Legal Services

Parent Supports

Peer Supports

Personal Attendant Care Services

Psychological testing or assessment

Recreational Activities

Rehabilitation Services (PT, OT, Speech Therapy)

Residential Services/Independent Support Living

Respite Care

Service Animals

Specific Disabilities (i.e. , Deafness, Developmental disabilities, etc)

Transportation resources

4. Please check all disabilities/conditions your agency serves:*

Autism Spectrum Disorders

Deafness/Hard of hearing

Developmental disabilities

Health related conditions

Learning disabilities

Neurological disabilities

Orthopedic conditions

Psychiatric disabilities

Respiratory Conditions

Neuromuscular conditions

Visual impairment /blindness

5. Regions Served:*

Central

East

Kansas City

Northeast

Northwest

Southeast

Southwest

St.Louis

6. Counties Served(Check all that apply - if all simply check "ALL"):*

ALL

Adair

Andrew

Atchison

Audrain

Barry

Barton

Bates

Benton

Bollinger

Boone

Buchanan

Butler

Caldwell

Callaway

Camden

Cape Girardeau

Carroll

Carter

Cass

Cedar

Chariton

Christian

Clark

Clay

Clinton

Cole

Cooper

Crawford

Dade

Dallas

Daviess

DeKalb

Dent

Douglas

Dunklin

Franklin

Gasconade

Gentry

Greene

Grundy

Harrison

Henry

Hickory

Holt

Howard

Howell

Iron

Jackson

Jasper

Jefferson

Johnson

Knox

Laclede

Lafayette

Lawrence

Lewis

Lincoln

Linn

Livingston

Macon

Madison

Maries

Marion

McDonald

Mercer

Miller

Mississippi

Moniteau

Monroe

Montgomery

Morgan

New Madrid

Newton

Nodaway

Oregon

Osage

Ozark

Pemiscot

Perry

Pettis

Phelps

Pike

Platte

Polk

Pulaski

Putnam

Ralls

Randolph

Ray

Reynolds

Ripley

Saline

Schuyler

Scotland

Scott

Shannon

Shelby

St. Charles

St. Clair

St. Francois

St. Louis

St. Louis City

Ste. Genevieve

Stoddard

Stone

Sullivan

Taney

Texas

Vernon

Warren

Washington

Wayne

Webster

Worth

Wright

Resource Directory Provider Update

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