Healthcare Provider Details

I. General information

NPI: 1336886506
Provider Name (Legal Business Name): KAITLIN M. KAUFMAN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2022
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7001 N LOCUST ST STE C203
GLADSTONE MO
64118-2531
US

IV. Provider business mailing address

7001 N LOCUST ST STE C203
GLADSTONE MO
64118-2531
US

V. Phone/Fax

Practice location:
  • Phone: 816-550-7008
  • Fax:
Mailing address:
  • Phone: 816-550-7008
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2023044022
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: