Healthcare Provider Details

I. General information

NPI: 1396671988
Provider Name (Legal Business Name): ELENA ITUARTE
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10820 W 64TH ST STE 201
SHAWNEE KS
66203-3571
US

IV. Provider business mailing address

10820 W 64TH ST STE 201
SHAWNEE KS
66203-3571
US

V. Phone/Fax

Practice location:
  • Phone: 913-353-5959
  • Fax:
Mailing address:
  • Phone: 913-353-5959
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: