1306177696 NPI number — ILENE BETH GRUNSPAN LSCSW, CEAP

Table of content: ILENE BETH GRUNSPAN LSCSW, CEAP (NPI 1306177696)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306177696 NPI number — ILENE BETH GRUNSPAN LSCSW, CEAP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GRUNSPAN
Provider First Name:
ILENE
Provider Middle Name:
BETH
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LSCSW, CEAP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1306177696
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/26/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12618 SLATER ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OVERLAND PARK
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66213-4721
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
913-832-0366
Provider Business Mailing Address Fax Number:
913-342-0069

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11111 NALL AVE
Provider Second Line Business Practice Location Address:
SUITE 103
Provider Business Practice Location Address City Name:
LEAWOOD
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66211-1924
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-832-0366
Provider Business Practice Location Address Fax Number:
913-342-0066
Provider Enumeration Date:
01/26/2010

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:  1880 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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