Healthcare Provider Details

I. General information

NPI: 1932134442
Provider Name (Legal Business Name): TINA R. DODSON L.P.N. / L.P.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5813 LAUREL AVE C/O POB 9565 / 5813 LAUREL AVE / T.DODSON, LPN / LPC
RAYTOWN MO
64133-3260
US

IV. Provider business mailing address

PO BOX 9565 POB 9565 / 5813 LAUREL AVE / T.DODSON, LPN / LPC
RAYTOWN MO
64133-0365
US

V. Phone/Fax

Practice location:
  • Phone: 816-550-9549
  • Fax: 816-313-6907
Mailing address:
  • Phone: 816-550-9549
  • Fax: 816-313-6907

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2001004045
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number032173
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: