MEDICARE: MS. SANDRA BOWLBY L.P.C., C.A.S.A.C.

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	101Y00000X	Counselor	002720	MO
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	2442	MO

General Provider Information

NPI Number	:	1730342254
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SANDRA BOWLBY L.P.C., C.A.S.A.C.

Provider Business Mailing Address
First Line	:	300 LAKESIDE DR
Second Line	:
City	:	LIBERTY
State	:	MO
Zip	:	64068-3442
Country	:	US
Telephone Number	:	816-365-9167
Fax Number	:	816-792-4845

Provider Business Practice Location Address
First Line	:	2301 BURLINGTON ST
Second Line	:
City	:	NORTH KANSAS CITY
State	:	MO
Zip	:	64116-3015
Country	:	US
Telephone Number	:	816-283-3396
Fax Number	:

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

Provider Enumeration Date	:	07/03/2008
Last Update Date	:	07/03/2008

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