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General NPI Number Information
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NPI Number | 1306354857
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Entity Type | Individual
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Provider Name | ABBIGAIL LYNN MOOG LSCSW
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Gender | Female
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Dates
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Enumeration Date | 01/18/2018
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Last Update Date | 01/18/2018
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Provider Practice Location Address
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Address Line | 4000 CAMBRIDGE ST MS 3007
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City | KANSAS CITY
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State | KS
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Zip | 66160-0001
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Country | US
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Telephone | 913-588-0677
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Fax | 913-588-0677
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Provider Business Mailing Address
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Address Line | 303 S STONECREST RD
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City | OLATHE
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State | KS
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Zip | 66061-7567
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Country | US
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Telephone | 913-428-6008
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 4733
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License Number State | KS
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