Healthcare Provider Details

I. General information

NPI: 1639992852
Provider Name (Legal Business Name): LAUREN SUSANNE KIVLAND
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/05/2024
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

888 HAINES STE 230
LIBERTY MO
64068-1008
US

IV. Provider business mailing address

4911 BUENA VISTA ST
ROELAND PARK KS
66205-1312
US

V. Phone/Fax

Practice location:
  • Phone: 816-797-9690
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number2025031419
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: