Healthcare Provider Details

I. General information

NPI: 1952121857
Provider Name (Legal Business Name): ISABEL LAUDERDALE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/15/2024
Last Update Date: 10/15/2024
Certification Date: 10/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1121 N 5T ST
KANSAS CITY KS
66101
US

IV. Provider business mailing address

1121 N 5TH ST
KANSAS CITY KS
66101-2305
US

V. Phone/Fax

Practice location:
  • Phone: 913-263-9515
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: