MEDICARE: SALLY KING MSW, LCSW, LSCSW

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	2006009661	MO

General Provider Information

NPI Number	:	1427112952
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SALLY KING MSW, LCSW, LSCSW

Provider Business Mailing Address
First Line	:	PO BOX 45052
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64171-8052
Country	:	US
Telephone Number	:	816-226-8211
Fax Number	:

Provider Business Practice Location Address
First Line	:	7423 SUMMIT ST
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64114-1523
Country	:	US
Telephone Number	:	816-226-8211
Fax Number	:

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

Provider Enumeration Date	:	12/20/2006
Last Update Date	:	12/23/2021

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