Healthcare Provider Details

I. General information

NPI: 1366010225
Provider Name (Legal Business Name): LILY KOPPEN LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2021
Last Update Date: 06/28/2021
Certification Date: 06/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7840 WASHINGTON AVE
KANSAS CITY KS
66112-2152
US

IV. Provider business mailing address

7840 WASHINGTON AVE
KANSAS CITY KS
66112-2152
US

V. Phone/Fax

Practice location:
  • Phone: 913-956-6500
  • Fax:
Mailing address:
  • Phone: 913-956-6500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number12211
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: