MEDICARE: MS. TRUDY ROYSTER MSW

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	101YM0800X	Mental Health Counselor		MO
2	1041C0700X	Clinical Social Worker		MO

General Provider Information

NPI Number	:	1134369853
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TRUDY ROYSTER MSW

Provider Business Mailing Address
First Line	:	12800 GARFIELD AVE
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64146-2113
Country	:	US
Telephone Number	:	816-941-0049
Fax Number	:

Provider Business Practice Location Address
First Line	:	12800 GARFIELD AVE
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64146-2113
Country	:	US
Telephone Number	:	816-941-0049
Fax Number	:

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

Provider Enumeration Date	:	02/21/2009
Last Update Date	:	02/21/2009

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Directions to “ MS. TRUDY ROYSTER MSW” Practice Location

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