Healthcare Provider Details

I. General information

NPI: 1639033012
Provider Name (Legal Business Name): LAVONDA MONIQUE CARRUTHERS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2025
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7495 W 161ST ST
OVERLAND PARK KS
66085-8854
US

IV. Provider business mailing address

507 S CHERRY ST
MURRAY KY
42071-2639
US

V. Phone/Fax

Practice location:
  • Phone: 913-225-7001
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: