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NPI Code Detail

MEDICARE: MRS. KAITLYN SUZANNE LICKTEIG

MEDICARE: MRS. KAITLYN SUZANNE LICKTEIG
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
1101YP2500XProfessional Counselor

General Provider Information

NPI Number : 1770183493
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. KAITLYN SUZANNE LICKTEIG
Provider Business Mailing Address
First Line : 8521 CRESCENT AVE
Second Line :
City : RAYTOWN
State : MO
Zip : 64138-3342
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 800 E 101ST TER STE 350
Second Line :
City : KANSAS CITY
State : MO
Zip : 64131-5310
Country : US
Telephone Number : 816-743-4673
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/30/2020
Last Update Date : 08/21/2024

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Directions to “ MRS. KAITLYN SUZANNE LICKTEIG ” Practice Location

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