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General NPI Number Information
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NPI Number | 1821405036
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Entity Type | Individual
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Provider Name | JESSICA AGUDELO BENITO DSW, LCSW
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Gender | Female
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Dates
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Enumeration Date | 07/20/2014
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Last Update Date | 01/24/2020
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Provider Practice Location Address
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Address Line | 435 NICHOLS RD STE 200
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City | KANSAS CITY
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State | MO
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Zip | 64112-2036
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Country | US
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Telephone | 816-368-2000
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 901348
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City | KANSAS CITY
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State | MO
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Zip | 64190-1348
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Country | US
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Telephone | 816-535-0975
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Fax | 816-298-1452
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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 | 092290
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 2018003790
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License Number State | MO
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