Healthcare Provider Details

I. General information

NPI: 1972420545
Provider Name (Legal Business Name): CAROLE CADUE-BLACKWOOD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2026
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 W 39TH ST
KANSAS CITY MO
64111-2910
US

IV. Provider business mailing address

600 W 39TH ST
KANSAS CITY MO
64111-2910
US

V. Phone/Fax

Practice location:
  • Phone: 816-421-7608
  • Fax:
Mailing address:
  • Phone: 816-421-7608
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number2024007727
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: