Healthcare Provider Details

I. General information

NPI: 1629497177
Provider Name (Legal Business Name): AMANDA ZANGRILLO PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2014
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5520 COLLEGE BLVD
LEAWOOD KS
66211-1630
US

IV. Provider business mailing address

2401 GILLHAM RD ATTN: PROVIDER ENROLLMENT DEPT
KANSAS CITY MO
64108-4619
US

V. Phone/Fax

Practice location:
  • Phone: 913-696-8000
  • Fax: 816-302-9939
Mailing address:
  • Phone: 816-701-5200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number03406
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number854
License Number StateNE
# 3
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number2025010400
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: