Healthcare Provider Details

I. General information

NPI: 1629832662
Provider Name (Legal Business Name): JENNIFER MEGAN BIRDSONG LCSW, LSCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/09/2024
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3640 NW 85TH ST
KANSAS CITY MO
64154-1164
US

IV. Provider business mailing address

3640 NW 85TH ST
KANSAS CITY MO
64154-1164
US

V. Phone/Fax

Practice location:
  • Phone: 816-721-1063
  • Fax: --
Mailing address:
  • Phone: 816-721-1063
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2025052985
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number07130
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: