MEDICARE: KRISTYNA TAN 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	05474	KS

General Provider Information

NPI Number	:	1720778582
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTYNA TAN LSCSW

Provider Business Mailing Address
First Line	:	1300 E 59TH ST
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64110-3240
Country	:	US
Telephone Number	:	816-810-0182
Fax Number	:

Provider Business Practice Location Address
First Line	:	1300 E 59TH ST
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64110-3240
Country	:	US
Telephone Number	:	816-810-0182
Fax Number	:

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

Provider Enumeration Date	:	05/15/2023
Last Update Date	:	05/15/2023

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Directions to “ KRISTYNA TAN LSCSW” Practice Location

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