Healthcare Provider Details

I. General information

NPI: 1871899435
Provider Name (Legal Business Name): KATHERINE RENEE MALONE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2011
Last Update Date: 05/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

136 E WALNUT ST STE 102
INDEPENDENCE MO
64050-3990
US

IV. Provider business mailing address

1217 NW WILLOW DR
GRAIN VALLEY MO
64029-8014
US

V. Phone/Fax

Practice location:
  • Phone: 816-318-4430
  • Fax:
Mailing address:
  • Phone: 816-920-3085
  • Fax: 816-581-3738

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6772
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2010039063
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: