Healthcare Provider Details

I. General information

NPI: 1861563231
Provider Name (Legal Business Name): ROCHELLE DEANN WALSH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/10/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19401 E US HIGHWAY 40 SUITE 140
INDEPENDENCE MO
64055-5450
US

IV. Provider business mailing address

2530 SW GOLDEN EAGLE RD
LEES SUMMIT MO
64082-4145
US

V. Phone/Fax

Practice location:
  • Phone: 816-373-6761
  • Fax:
Mailing address:
  • Phone: 816-525-2670
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1999135422
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2148
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: