Healthcare Provider Details

I. General information

NPI: 1164803961
Provider Name (Legal Business Name): DAWN DIAZ LSCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2015
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2211 S 55TH ST
KANSAS CITY KS
66106-2246
US

IV. Provider business mailing address

10013 MELROSE ST
OVERLAND PARK KS
66214-2300
US

V. Phone/Fax

Practice location:
  • Phone: 913-288-3331
  • Fax:
Mailing address:
  • Phone: 913-205-9456
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number07147
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2019007099
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: