MEDICARE: MS. PAMELA DENISE THORP SR. LCSW

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	005547	MO
2	1041C0700X	Clinical Social Worker	1536	KS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1536	OTHER	KS	KS LICENSE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1740394998
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. PAMELA DENISE THORP SR. LCSW

Provider Business Mailing Address
First Line	:	2401 GILLHAM RD
Second Line	:	PROVIDER ENROLLMENT
City	:	KANSAS CITY
State	:	MO
Zip	:	64108-4619
Country	:	US
Telephone Number	:	816-701-5200
Fax Number	:	816-302-9939

Provider Business Practice Location Address
First Line	:	718 E 71ST TER
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64131-1614
Country	:	US
Telephone Number	:	816-210-7991
Fax Number	:

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

Provider Enumeration Date	:	08/17/2006
Last Update Date	:	06/28/2017

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