Healthcare Provider Details

I. General information

NPI: 1205024346
Provider Name (Legal Business Name): GORDON PARKS ELEMENTARY SCHOOL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2007
Last Update Date: 10/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3715 WYOMING ST
KANSAS CITY MO
64111-3945
US

IV. Provider business mailing address

3715 WYOMING ST
KANSAS CITY MO
64111-3945
US

V. Phone/Fax

Practice location:
  • Phone: 816-753-6700
  • Fax: 816-753-3436
Mailing address:
  • Phone: 816-753-6700
  • Fax: 816-753-3436

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2004009863
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2004034170
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2004035091
License Number StateMO

VIII. Authorized Official

Name: HANNAH CHAMBERLAIN
Title or Position: DIRECTOR OF SPECIAL SERVICES
Credential:
Phone: 816-753-6700