MEDICARE: MS. GLORIA A EGNER JESTER LCSW KS LCSW MO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	2000153563	MO
2	1041C0700X	Clinical Social Worker	1454	KS

General Provider Information

NPI Number	:	1053465906
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. GLORIA A EGNER JESTER LCSW KS LCSW MO

Provider Business Mailing Address
First Line	:	4700 S CEDARCREST CT
Second Line	:	SUITE 12
City	:	INDEPENDENCE
State	:	MO
Zip	:	64055
Country	:	US
Telephone Number	:	816-350-7179
Fax Number	:	816-350-3962

Provider Business Practice Location Address
First Line	:	4700 S CEDARCREST CT
Second Line	:	SUITE 12
City	:	INDEPENDENCE
State	:	MO
Zip	:	64055
Country	:	US
Telephone Number	:	816-350-7179
Fax Number	:	816-350-3962

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/22/2007
Last Update Date	:	07/08/2007

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