MEDICARE: LAVONDA MONIQUE CARRUTHERS

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	106S00000X	Behavior Technician		KY

General Provider Information

NPI Number	:	1639033012
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAVONDA MONIQUE CARRUTHERS

Provider Business Mailing Address
First Line	:	507 S CHERRY ST
Second Line	:
City	:	MURRAY
State	:	KY
Zip	:	42071-2639
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7495 W 161ST ST
Second Line	:
City	:	OVERLAND PARK
State	:	KS
Zip	:	66085-8854
Country	:	US
Telephone Number	:	913-225-7001
Fax Number	:

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

Provider Enumeration Date	:	12/10/2025
Last Update Date	:	12/10/2025

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Directions to “ LAVONDA MONIQUE CARRUTHERS ” Practice Location

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