1033274188 NPI number — MRS. BARBARA JANE DICKERSON LCSW

Table of content: MRS. BARBARA JANE DICKERSON LCSW (NPI 1033274188)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033274188 NPI number — MRS. BARBARA JANE DICKERSON LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DICKERSON
Provider First Name:
BARBARA
Provider Middle Name:
JANE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GUINN
Provider Other First Name:
BARBARA
Provider Other Middle Name:
JANE
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
MSW
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1033274188
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/15/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3100 BROADWAY BLVD 410
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KANSAS CITY
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64111-2655
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
816-405-1341
Provider Business Mailing Address Fax Number:
816-753-7744

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12600E US HIGHWAY 40 101
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
INDEPENDENCE
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64055-5909
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-405-1341
Provider Business Practice Location Address Fax Number:
816-753-7744
Provider Enumeration Date:
12/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  000271 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 496962101 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".




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