Healthcare Provider Details

I. General information

NPI: 1477272268
Provider Name (Legal Business Name): RYAN KEITH SPEED
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2022
Last Update Date: 03/24/2026
Certification Date: 03/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6155 OAK ST STE A5
KANSAS CITY MO
64113-2240
US

IV. Provider business mailing address

6429 CHARLOTTE ST
KANSAS CITY MO
64131-1104
US

V. Phone/Fax

Practice location:
  • Phone: 913-228-2422
  • Fax:
Mailing address:
  • Phone: 913-228-2422
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2025053709
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number07115
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: