Healthcare Provider Details

I. General information

NPI: 1497939094
Provider Name (Legal Business Name): LEE A NELSON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2007
Last Update Date: 12/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3031 M 291 FRONTAGE RD
INDEPENDENCE MO
64057-2334
US

IV. Provider business mailing address

3031 M 291 FRONTAGE RD
INDEPENDENCE MO
64057-2334
US

V. Phone/Fax

Practice location:
  • Phone: 816-373-9240
  • Fax:
Mailing address:
  • Phone: 816-373-9240
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number004429
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: