MEDICARE: MR. JOHN MICHAEL WUBBENHORST SR. MS

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	103T00000X	Psychologist	PY00348	MO
2	103TC0700X	Clinical Psychologist	PY00348	MO
3	103TH0100X	Health Service Psychologist	PY00348	MO

General Provider Information

NPI Number	:	1245226745
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOHN MICHAEL WUBBENHORST SR. MS

Provider Business Mailing Address
First Line	:	3100 BROADWAY ST
Second Line	:	SUITE 1104
City	:	KANSAS CITY
State	:	MO
Zip	:	64111-2658
Country	:	US
Telephone Number	:	816-753-3333
Fax Number	:	616-753-7744

Provider Business Practice Location Address
First Line	:	3100 BROADWAY ST
Second Line	:	SUITE 1104
City	:	KANSAS CITY
State	:	MO
Zip	:	64111-2658
Country	:	US
Telephone Number	:	816-753-3333
Fax Number	:	616-753-7744

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

Provider Enumeration Date	:	09/21/2005
Last Update Date	:	09/11/2025

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