Healthcare Provider Details

I. General information

NPI: 1588993943
Provider Name (Legal Business Name): USD 500
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2009
Last Update Date: 12/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4601 STATE AVE STE 38.SPED
KANSAS CITY KS
66102-3603
US

IV. Provider business mailing address

4601 STATE AVE STE 38.SPED
KANSAS CITY KS
66102-3603
US

V. Phone/Fax

Practice location:
  • Phone: 913-627-5676
  • Fax: 913-627-5688
Mailing address:
  • Phone: 913-627-5676
  • Fax: 913-627-5688

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number State

VIII. Authorized Official

Name: MS. BARBARA PRETZ
Title or Position: PROJECT MANAGER
Credential:
Phone: 913-627-5676