Healthcare Provider Details

I. General information

NPI: 1720994312
Provider Name (Legal Business Name): KIM ANTOINETTE ZOLTEK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2026
Last Update Date: 08/22/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18931 E VALLEY VIEW PKWY
INDEPENDENCE MO
64055-7012
US

IV. Provider business mailing address

312 NW BRADFORD ST
LEES SUMMIT MO
64064-1877
US

V. Phone/Fax

Practice location:
  • Phone: 816-852-3804
  • Fax:
Mailing address:
  • Phone: 816-456-8451
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2025039417
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: