MEDICARE: BLAIR SWADLEY 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
1	1041C0700X	Clinical Social Worker	2018029244	MO

General Provider Information

NPI Number	:	1922635622
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BLAIR SWADLEY LCSW

Provider Business Mailing Address
First Line	:	2900 CLAY EDWARDS DR
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64116-3235
Country	:	US
Telephone Number	:	816-372-8288
Fax Number	:

Provider Business Practice Location Address
First Line	:	2900 CLAY EDWARDS DR
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64116-3235
Country	:	US
Telephone Number	:	816-372-8288
Fax Number	:

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

Provider Enumeration Date	:	03/24/2020
Last Update Date	:	03/24/2020

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