MEDICARE: MS. SANDRA LYNN LYKE 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
1	1041C0700X	Clinical Social Worker	000405	MO

General Provider Information

NPI Number	:	1972786481
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SANDRA LYNN LYKE LCSW

Provider Business Mailing Address
First Line	:	1833 SWOPE PKWY
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64130-2554
Country	:	US
Telephone Number	:	816-507-1298
Fax Number	:

Provider Business Practice Location Address
First Line	:	1833 SWOPE PKWY
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64130-2554
Country	:	US
Telephone Number	:	816-507-1298
Fax Number	:

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

Provider Enumeration Date	:	12/07/2007
Last Update Date	:	04/01/2013

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