MEDICARE: JON EFFERTZ

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	2017016842	MO

General Provider Information

NPI Number	:	1447767314
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JON EFFERTZ

Provider Business Mailing Address
First Line	:	2101 SW 1ST ST
Second Line	:
City	:	LEES SUMMIT
State	:	MO
Zip	:	64081-4030
Country	:	US
Telephone Number	:	816-877-6995
Fax Number	:

Provider Business Practice Location Address
First Line	:	600 NW MURRAY RD STE 110
Second Line	:
City	:	LEES SUMMIT
State	:	MO
Zip	:	64081-1238
Country	:	US
Telephone Number	:	816-272-5656
Fax Number	:

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

Provider Enumeration Date	:	01/02/2018
Last Update Date	:	01/02/2018

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Directions to “ JON EFFERTZ ” Practice Location

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