Healthcare Provider Details

I. General information

NPI: 1285991745
Provider Name (Legal Business Name): LARRY J KUTSCHER LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2012
Last Update Date: 04/20/2012
Certification Date:
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 SUITE 130
MISSION KS
66202-3234
US

V. Phone/Fax

Practice location:
  • Phone: 913-826-4000
  • Fax: 913-826-1589
Mailing address:
  • Phone: 913-831-2550
  • Fax: 913-826-1589

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number7959
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: