Healthcare Provider Details

I. General information

NPI: 1659398428
Provider Name (Legal Business Name): LAURA N BREITBERG LSCSW LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5801 W 115TH STREET SUITE 103
OVERLAND PARK KS
64114
US

IV. Provider business mailing address

5801 W 115TH STREET SUITE 103
OVERLAND PARK KS
66211
US

V. Phone/Fax

Practice location:
  • Phone: 913-827-8250
  • Fax: 913-827-8222
Mailing address:
  • Phone: 913-827-8250
  • Fax: 913-827-8222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2138
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2001004051
License Number StateMO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier27983018
Identifier TypeOTHER
Identifier StateMO
Identifier IssuerBC BS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: