Healthcare Provider Details

I. General information

NPI: 1154757128
Provider Name (Legal Business Name): LEANN MARIE KECK LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2013
Last Update Date: 09/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2905 W 72ND ST
PRAIRIE VILLAGE KS
66208-3149
US

IV. Provider business mailing address

2905 W 72ND ST
PRAIRIE VILLAGE KS
66208-3149
US

V. Phone/Fax

Practice location:
  • Phone: 913-638-8896
  • Fax:
Mailing address:
  • Phone: 913-638-8896
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number2011028235
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: