Healthcare Provider Details

I. General information

NPI: 1942334891
Provider Name (Legal Business Name): KERRY E. MORRELL LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 04/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 W 15TH ST
PLEASANTON KS
66075-4095
US

IV. Provider business mailing address

304 N JEFFERSON AVE
IOLA KS
66749-2327
US

V. Phone/Fax

Practice location:
  • Phone: 913-352-8214
  • Fax:
Mailing address:
  • Phone: 620-365-8641
  • Fax: 620-365-8642

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2007006564
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number4000
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: