Healthcare Provider Details

I. General information

NPI: 1477176956
Provider Name (Legal Business Name): ANGELIQUE TEMBO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2020
Last Update Date: 05/19/2020
Certification Date: 05/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2901 TROOST AVE
KANSAS CITY MO
64109-1538
US

IV. Provider business mailing address

9209 E 84TH CT
RAYTOWN MO
64138-3481
US

V. Phone/Fax

Practice location:
  • Phone: 816-309-6885
  • Fax:
Mailing address:
  • Phone: 816-349-8826
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number2020005855
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number2020005855
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: