Healthcare Provider Details

I. General information

NPI: 1639611510
Provider Name (Legal Business Name): LORI KANKE, LCSW, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2016
Last Update Date: 06/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2404 HIGHLY ST
SAINT JOSEPH MO
64506
US

IV. Provider business mailing address

2404 HIGHLY ST
SAINT JOSEPH MO
64506-2729
US

V. Phone/Fax

Practice location:
  • Phone: 816-351-9026
  • Fax: 816-387-9307
Mailing address:
  • Phone: 816-351-9026
  • Fax: 816-387-9307

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2015004773
License Number StateMO

VIII. Authorized Official

Name: LORI ANN KANKE
Title or Position: OWNER
Credential: LCSW
Phone: 816-351-9026