MEDICARE: BRENDA J SALLEY 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
1	103TC2200X	Clinical Child & Adolescent Psychologist	2015032104	MO
2	103TC2200X	Clinical Child & Adolescent Psychologist	2132	KS

General Provider Information

NPI Number	:	1851737324
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRENDA J SALLEY PHD

Provider Business Mailing Address
First Line	:	2106 OLATHE BLVD MS 4004
Second Line	:
City	:	KANSAS CITY
State	:	KS
Zip	:	66160-4619
Country	:	US
Telephone Number	:	913-588-6300
Fax Number	:

Provider Business Practice Location Address
First Line	:	2000 OLATHE BLVD
Second Line	:
City	:	KANSAS CITY
State	:	KS
Zip	:	66160-4619
Country	:	US
Telephone Number	:	913-588-6300
Fax Number	:	913-588-2253

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

Provider Enumeration Date	:	05/10/2013
Last Update Date	:	12/18/2025

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