Healthcare Provider Details

I. General information

NPI: 1902313547
Provider Name (Legal Business Name): MIA G WITHINGTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2018
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 NE 46TH ST
KANSAS CITY MO
64116-2042
US

IV. Provider business mailing address

5413 NE 56TH PL
KANSAS CITY MO
64119-2428
US

V. Phone/Fax

Practice location:
  • Phone: 816-321-5000
  • Fax:
Mailing address:
  • Phone: 816-668-5253
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number2026025001
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: