MEDICARE: KATHRYN LYNDSAY CROCKETT SOCIAL WORKER

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	171M00000X	Case Manager/Care Coordinator		KS

General Provider Information

NPI Number	:	1932255023
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHRYN LYNDSAY CROCKETT SOCIAL WORKER

Provider Business Mailing Address
First Line	:	702 N 75TH ST
Second Line	:
City	:	KANSAS CITY
State	:	KS
Zip	:	66112-2829
Country	:	US
Telephone Number	:	913-299-9457
Fax Number	:	913-299-1649

Provider Business Practice Location Address
First Line	:	702 N 75TH ST
Second Line	:
City	:	KANSAS CITY
State	:	KS
Zip	:	66112-2829
Country	:	US
Telephone Number	:	913-299-9457
Fax Number	:	913-299-1649

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

Provider Enumeration Date	:	01/25/2007
Last Update Date	:	07/09/2007

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