MEDICARE: POLLOCK GROUP, LLC

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	103TC0700X	Clinical Psychologist	PY1767	MO

General Provider Information

NPI Number	:	1467418525
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	POLLOCK GROUP, LLC

Provider Business Mailing Address
First Line	:	8080 WARD PKWY
Second Line	:	#230
City	:	KANSAS CITY
State	:	MO
Zip	:	64114-2034
Country	:	US
Telephone Number	:	816-822-1922
Fax Number	:	816-822-2248

Provider Business Practice Location Address
First Line	:	8080 WARD PKWY
Second Line	:	#230
City	:	KANSAS CITY
State	:	MO
Zip	:	64114-2034
Country	:	US
Telephone Number	:	816-822-1922
Fax Number	:	816-822-2248

Authorized Official
Title or Position	:	CLINIC MANAGER
Name	:	MRS. MARY A SPICER
Credential	:
Telephone Number	:	816-822-1922

Provider Enumeration Date	:	04/25/2006
Last Update Date	:	04/08/2008

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Directions to “POLLOCK GROUP, LLC ” Practice Location

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