Healthcare Provider Details

I. General information

NPI: 1235067257
Provider Name (Legal Business Name): JOHANNA BANFILL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2026
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 E 101ST TER STE 350
KANSAS CITY MO
64131-5310
US

IV. Provider business mailing address

9410 ECHO LN
SAINT LOUIS MO
63114-3708
US

V. Phone/Fax

Practice location:
  • Phone: 314-378-3073
  • Fax:
Mailing address:
  • Phone: 314-378-3073
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: