MEDICARE: CHERYL GUNN SEIDLER 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	002256	MO

General Provider Information

NPI Number	:	1114533411
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHERYL GUNN SEIDLER LCSW

Provider Business Mailing Address
First Line	:	8662 N OREGON AVE
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64154-2720
Country	:	US
Telephone Number	:	816-651-6672
Fax Number	:

Provider Business Practice Location Address
First Line	:	5775 NW 64TH TER STE 201
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64151-3980
Country	:	US
Telephone Number	:	816-425-3267
Fax Number	:

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

Provider Enumeration Date	:	09/22/2020
Last Update Date	:	07/09/2023

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