Healthcare Provider Details

I. General information

NPI: 1053097303
Provider Name (Legal Business Name): RILEY ROSSETTI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RILEY WOHLRAB

II. Dates (important events)

Enumeration Date: 06/22/2023
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15064 ANTIOCH RD
OVERLAND PARK KS
66221-8502
US

IV. Provider business mailing address

11901 W 100TH ST
LENEXA KS
66215-1939
US

V. Phone/Fax

Practice location:
  • Phone: 913-735-9291
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number07323
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number13131
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: