Healthcare Provider Details

I. General information

NPI: 1598094278
Provider Name (Legal Business Name): SHEDRIKA ATWOOD MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/09/2009
Last Update Date: 12/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12209 E 55TH ST
KANSAS CITY MO
64133-3106
US

IV. Provider business mailing address

12209 E 55TH ST
KANSAS CITY MO
64133-3106
US

V. Phone/Fax

Practice location:
  • Phone: 816-359-1581
  • Fax: 816-255-3408
Mailing address:
  • Phone: 816-359-1581
  • Fax: 816-255-3408

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number6207-11776
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: