MEDICARE: MR. ROBERT GREY ENDRES DSW, LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	005152	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033253083
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ROBERT GREY ENDRES DSW, LCSW

Provider Business Mailing Address
First Line	:	8025 LEWIS DR
Second Line	:
City	:	LENEXA
State	:	KS
Zip	:	66227-2215
Country	:	US
Telephone Number	:	913-441-0119
Fax Number	:

Provider Business Practice Location Address
First Line	:	1508 SW WHITE RIDGE DR
Second Line	:
City	:	LEES SUMMIT
State	:	MO
Zip	:	64081-2433
Country	:	US
Telephone Number	:	816-836-2920
Fax Number	:	816-836-2923

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/15/2007
Last Update Date	:	05/13/2020

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