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NPI Code Detail

MEDICARE: STEPHEN MICHAEL KANNE PHD

MEDICARE: STEPHEN MICHAEL KANNE PHD
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
1103T00000XPsychologist2000166652MO
2103TC0700XClinical Psychologist2000166652MO

General Provider Information

NPI Number : 1780648014
Entity Type Code : Individual
Provider Name (Legal Business Name) : STEPHEN MICHAEL KANNE PHD
Provider Business Mailing Address
First Line : PO BOX 843966
Second Line :
City : KANSAS CITY
State : MO
Zip : 64184-3966
Country : US
Telephone Number : 573-884-3300
Fax Number : 573-884-0943
Provider Business Practice Location Address
First Line : 205 PORTLAND ST
Second Line :
City : COLUMBIA
State : MO
Zip : 65201-6521
Country : US
Telephone Number : 573-884-6052
Fax Number : 573-884-1151
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/13/2006
Last Update Date : 05/19/2025

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