Healthcare Provider Details

I. General information

NPI: 1295653459
Provider Name (Legal Business Name): GRACE BOLAMPERTI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2026
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4701 COLLEGE BLVD STE 115
LEAWOOD KS
66211-1608
US

IV. Provider business mailing address

4429 W 52ND TER
ROELAND PARK KS
66205-2305
US

V. Phone/Fax

Practice location:
  • Phone: 913-777-4020
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: