Healthcare Provider Details

I. General information

NPI: 1104265289
Provider Name (Legal Business Name): MARY L NEUBURGER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARY L GING

II. Dates (important events)

Enumeration Date: 06/21/2013
Last Update Date: 08/19/2022
Certification Date: 08/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6000 LAMAR AVE STE 130
MISSION KS
66202-3234
US

IV. Provider business mailing address

6000 LAMAR AVE STE 130
MISSION KS
66202-3234
US

V. Phone/Fax

Practice location:
  • Phone: 913-826-4200
  • Fax:
Mailing address:
  • Phone: 913-826-4200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number8192
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2011032485
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: