Healthcare Provider Details

I. General information

NPI: 1598033441
Provider Name (Legal Business Name): AMY LAUREN WILSON MA, MT-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2011
Last Update Date: 12/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 BROADWAY SUITE 1000
KANSAS CITY MO
64111-2658
US

IV. Provider business mailing address

609 S. SUNSET DR
OLATHE KS
66061-4942
US

V. Phone/Fax

Practice location:
  • Phone: 816-756-1160
  • Fax:
Mailing address:
  • Phone: 913-940-3181
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number08172
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: