Healthcare Provider Details

I. General information

NPI: 1265341713
Provider Name (Legal Business Name): CLUB CAN-COMMUNITY APPRECIATING NEURODIVERSITY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8345 ACUFF LN
LENEXA KS
66215-5303
US

IV. Provider business mailing address

PO BOX 14218
LENEXA KS
66285-4218
US

V. Phone/Fax

Practice location:
  • Phone: 816-588-8280
  • Fax:
Mailing address:
  • Phone: 816-588-8280
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: KELSEY KAESTNER
Title or Position: EXECUTIVE DIRECTOR
Credential: M.S., CCC-SLP
Phone: 816-588-8280