MEDICARE: REBECCA RUTH KAISER L.P.C.

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	101YM0800X	Mental Health Counselor	OO2348	MO

General Provider Information

NPI Number	:	1881679041
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBECCA RUTH KAISER L.P.C.

Provider Business Mailing Address
First Line	:	5004 W 73RD ST
Second Line	:
City	:	PRAIRIE VILLAGE
State	:	KS
Zip	:	66208-2431
Country	:	US
Telephone Number	:	913-403-9803
Fax Number	:

Provider Business Practice Location Address
First Line	:	3100 BROADWAY ST
Second Line	:	SUITE 1104
City	:	KANSAS CITY
State	:	MO
Zip	:	64111-2658
Country	:	US
Telephone Number	:	816-753-3333
Fax Number	:	816-753-7744

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

Provider Enumeration Date	:	12/09/2005
Last Update Date	:	07/08/2007

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