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General NPI Number Information
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NPI Number | 1407625841
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Entity Type | Individual
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Provider Name | CRYSTAL KAY SPROUSE LMSW
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Gender | Female
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Dates
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Enumeration Date | 12/27/2023
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Last Update Date | 12/27/2023
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Provider Practice Location Address
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Address Line | 4801 E LINWOOD BLVD
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City | KANSAS CITY
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State | MO
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Zip | 64128-2226
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Country | US
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Telephone | 816-681-0556
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Fax |
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Provider Business Mailing Address
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Address Line | 446 W 63RD ST
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City | KANSAS CITY
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State | MO
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Zip | 64113-1620
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Country | US
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Telephone | 816-612-0641
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 2023044932
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License Number State | MO
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