MEDICARE: MRS. LISA KAY DALY 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	1041C0700X	Clinical Social Worker	2369	MO
2	1041C0700X	Clinical Social Worker	2430	KS

General Provider Information

NPI Number	:	1346297512
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LISA KAY DALY MSW

Provider Business Mailing Address
First Line	:	511 E 106TH ST
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64131-4313
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3100 NE 83RD ST
Second Line	:	SUITE 1401
City	:	KANSAS CITY
State	:	MO
Zip	:	64119-4400
Country	:	US
Telephone Number	:	816-436-0486
Fax Number	:	816-436-0973

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

Provider Enumeration Date	:	05/31/2006
Last Update Date	:	07/08/2007

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