MEDICARE: JODI LYN MASON-EISENHAUER LCP

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	103T00000X	Psychologist	033	KS

General Provider Information

NPI Number	:	1962411371
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JODI LYN MASON-EISENHAUER LCP

Provider Business Mailing Address
First Line	:	6405 METCALF AVE
Second Line	:	SUITE 322
City	:	OVERLAND PARK
State	:	KS
Zip	:	66202-3927
Country	:	US
Telephone Number	:	913-961-3486
Fax Number	:

Provider Business Practice Location Address
First Line	:	6405 METCALF AVE
Second Line	:	SUITE 322
City	:	OVERLAND PARK
State	:	KS
Zip	:	66202-3927
Country	:	US
Telephone Number	:	913-961-3486
Fax Number	:

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

Provider Enumeration Date	:	08/05/2006
Last Update Date	:	07/08/2007

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