Healthcare Provider Details

I. General information

NPI: 1184842775
Provider Name (Legal Business Name): MARY LYNN WARMBRODT PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2007
Last Update Date: 10/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14920 E 49TH TER
KANSAS CITY MO
64136-1305
US

IV. Provider business mailing address

14920 E 49TH TER
KANSAS CITY MO
64136-1305
US

V. Phone/Fax

Practice location:
  • Phone: 816-373-7037
  • Fax:
Mailing address:
  • Phone: 816-373-7037
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License NumberRO371
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberRO371
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: