Healthcare Provider Details

I. General information

NPI: 1295306033
Provider Name (Legal Business Name): KELSI HINRICHS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2021
Last Update Date: 08/07/2024
Certification Date: 08/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 NE COLBERN RD STE 200
LEES SUMMIT MO
64086-4711
US

IV. Provider business mailing address

520 NE COLBERN RD STE 200
LEES SUMMIT MO
64086-4711
US

V. Phone/Fax

Practice location:
  • Phone: 816-643-4959
  • Fax:
Mailing address:
  • Phone: 816-643-4959
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-24-74783
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: