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General NPI Number Information
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NPI Number | 1851671051
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Entity Type | Individual
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Provider Name | RYANN ANNE MALLONEE LCSW
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Gender | Female
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Dates
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Enumeration Date | 08/19/2011
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Last Update Date | 10/20/2016
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Provider Practice Location Address
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Address Line | 6 VICTORY LN STE 102
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City | LIBERTY
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State | MO
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Zip | 64068-2395
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Country | US
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Telephone | 816-678-1420
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Fax |
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Provider Business Mailing Address
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Address Line | 12577 STATE ROUTE 92
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City | KEARNEY
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State | MO
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Zip | 64060
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Country | US
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Telephone | 816-678-1420
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Fax | 816-533-4106
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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 | 2009009730
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License Number State | MO
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