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NPI Code Detail

MEDICARE: LANDON LEE KIRK MSW, LCSW

MEDICARE: LANDON LEE KIRK MSW, 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
11041C0700XClinical Social Worker2007006610MO

General Provider Information

NPI Number : 1811222573
Entity Type Code : Individual
Provider Name (Legal Business Name) : LANDON LEE KIRK MSW, LCSW
Provider Business Mailing Address
First Line : 130 CALO LN
Second Line :
City : LAKE OZARK
State : MO
Zip : 65049-9208
Country : US
Telephone Number : 573-365-2221
Fax Number : 573-365-2224
Provider Business Practice Location Address
First Line : 130 CALO LN
Second Line :
City : LAKE OZARK
State : MO
Zip : 65049-9208
Country : US
Telephone Number : 573-365-2221
Fax Number : 573-365-2224
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/13/2009
Last Update Date : 10/13/2009

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