Healthcare Provider Details

I. General information

NPI: 1497991228
Provider Name (Legal Business Name): AMANDA JEAN KOCSIS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMANDA JEAN PARK LCSW

II. Dates (important events)

Enumeration Date: 12/29/2008
Last Update Date: 12/07/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4801 E LINWOOD BLVD
KANSAS CITY MO
64128-2226
US

IV. Provider business mailing address

7110 BROCKWAY ST
SHAWNEE KS
66227-2145
US

V. Phone/Fax

Practice location:
  • Phone: 816-861-4700
  • Fax:
Mailing address:
  • Phone: 720-261-5202
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1174
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: