MEDICARE: JACQUELINE ELAINE KEITEL LCSW, LSCSW

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	2003022197	MO
2	1041C0700X	Clinical Social Worker	2387	KS

General Provider Information

NPI Number	:	1821254061
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACQUELINE ELAINE KEITEL LCSW, LSCSW

Provider Business Mailing Address
First Line	:	7280 NW 87TH TER
Second Line	:	SUITE 210
City	:	KANSAS CITY
State	:	MO
Zip	:	64153-3720
Country	:	US
Telephone Number	:	816-872-2463
Fax Number	:	816-533-7220

Provider Business Practice Location Address
First Line	:	7280 NW 87TH TER
Second Line	:	SUITE 210
City	:	KANSAS CITY
State	:	MO
Zip	:	64153-3720
Country	:	US
Telephone Number	:	816-872-2463
Fax Number	:	816-533-7220

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

Provider Enumeration Date	:	08/06/2008
Last Update Date	:	08/09/2010

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