Healthcare Provider Details

I. General information

NPI: 1679416960
Provider Name (Legal Business Name): VICTORIA L OOTHOUDT LCSW, LSCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2026
Last Update Date: 04/11/2026
Certification Date: 04/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 NE 54TH ST STE 205
KANSAS CITY MO
64118-4389
US

IV. Provider business mailing address

200 NE 54TH ST STE 205
KANSAS CITY MO
64118-4389
US

V. Phone/Fax

Practice location:
  • Phone: 337-718-9859
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number06580
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2025043980
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: