Healthcare Provider Details

I. General information

NPI: 1730001819
Provider Name (Legal Business Name): JACK WILLIAMS RBT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2026
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5350 COLLEGE BLVD
LEAWOOD KS
66211-1936
US

IV. Provider business mailing address

5350 COLLEGE BLVD
LEAWOOD KS
66211-1936
US

V. Phone/Fax

Practice location:
  • Phone: 816-994-5681
  • Fax: 816-994-8683
Mailing address:
  • Phone: 816-859-3619
  • Fax: 816-994-5683

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-26-2834558
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: