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NPI Code Detail

MEDICARE: MS. TRACY LYNN WITHROW LCSW

MEDICARE: MS. TRACY LYNN WITHROW LCSW
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
11041C0700XClinical Social WorkerLCSW 2006004078MO
21041C0700XClinical Social WorkerLSCSW 1889KS

General Provider Information

NPI Number : 1255386025
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. TRACY LYNN WITHROW LCSW
Provider Business Mailing Address
First Line : 2 E 59TH ST
Second Line :
City : KANSAS CITY
State : MO
Zip : 64113-2116
Country : US
Telephone Number : 816-363-1898
Fax Number : 816-822-7711
Provider Business Practice Location Address
First Line : 2 E 59TH ST
Second Line :
City : KANSAS CITY
State : MO
Zip : 64113-2116
Country : US
Telephone Number : 816-363-1898
Fax Number : 816-822-7711
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/23/2006
Last Update Date : 07/08/2007

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