MEDICARE: MS. EVA ELAINE HUSTED LSCSW/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	2164	KS
2	1041C0700X	Clinical Social Worker	004654	MO

General Provider Information

NPI Number	:	1770574477
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. EVA ELAINE HUSTED LSCSW/LCSW

Provider Business Mailing Address
First Line	:	10323 N TRACY AVE
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64155-1994
Country	:	US
Telephone Number	:	816-734-7104
Fax Number	:	816-734-1202

Provider Business Practice Location Address
First Line	:	10323 N TRACY AVE
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64155-1994
Country	:	US
Telephone Number	:	816-260-0250
Fax Number	:

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

Provider Enumeration Date	:	11/02/2005
Last Update Date	:	07/08/2024

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