Healthcare Provider Details

I. General information

NPI: 1619300191
Provider Name (Legal Business Name): NADIN R. RIZK PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2013
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

218 NW OLDHAM PKWY
LEES SUMMIT MO
64081-1520
US

IV. Provider business mailing address

218 NW OLDHAM PKWY
LEES SUMMIT MO
64081-1520
US

V. Phone/Fax

Practice location:
  • Phone: 816-237-0670
  • Fax:
Mailing address:
  • Phone: 816-237-0670
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number2017038051
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: