MEDICARE: DERICK LETMAN

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	104100000X	Social Worker	2022005730	MO

General Provider Information

NPI Number	:	1154028280
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DERICK LETMAN

Provider Business Mailing Address
First Line	:	4801 E LINWOOD BLVD
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64128-2295
Country	:	US
Telephone Number	:	816-861-4700
Fax Number	:

Provider Business Practice Location Address
First Line	:	4801 E LINWOOD BLVD
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64128-2295
Country	:	US
Telephone Number	:	816-861-4700
Fax Number	:

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

Provider Enumeration Date	:	02/09/2023
Last Update Date	:	02/09/2023

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Directions to “ DERICK LETMAN ” Practice Location

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