Healthcare Provider Details

I. General information

NPI: 1144825985
Provider Name (Legal Business Name): KENDRA VANFOSSEN LMSW, LMAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2020
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6440 NIEMAN RD
SHAWNEE KS
66203-3326
US

IV. Provider business mailing address

6000 LAMAR AVE STE 130
MISSION KS
66202-3299
US

V. Phone/Fax

Practice location:
  • Phone: 913-826-4200
  • Fax:
Mailing address:
  • Phone: 913-826-4200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number00904
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number07223
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: