=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295870996
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARGARET A. FALLON PH.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/20/2007
-----------------------------------------------------
Last Update Date | 11/05/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | STATELINE EXECUTIVE OFFICE PARK 8010 STATELINE RD.
-----------------------------------------------------
City | PRAIRIE VILLAGE
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 66208
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 913-789-7899
-----------------------------------------------------
Fax | 913-901-8225
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 19491
-----------------------------------------------------
City | LENEXA
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 66285-9491
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 913-789-7899
-----------------------------------------------------
Fax | 913-901-8225
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103T00000X
-----------------------------------------------------
Taxonomy Name | Psychologist
-----------------------------------------------------
License Number | PSYC 01385
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 103T00000X
-----------------------------------------------------
Taxonomy Name | Psychologist
-----------------------------------------------------
License Number | 2612
-----------------------------------------------------
License Number State | KS
-----------------------------------------------------