Healthcare Provider Details

I. General information

NPI: 1730255092
Provider Name (Legal Business Name): HEATHER ANNE CARPENTER MSW, LCSW, LSCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 04/06/2023
Certification Date: 04/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8400 W 110TH ST
OVERLAND PARK KS
66210-2331
US

IV. Provider business mailing address

8400 W 110TH ST
OVERLAND PARK KS
66210-2331
US

V. Phone/Fax

Practice location:
  • Phone: 913-327-7505
  • Fax: 913-327-7054
Mailing address:
  • Phone: 913-327-7505
  • Fax: 913-327-7054

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number002940
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1473
License Number StateKS

VII. Legacy identifiers

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: