1619033586 NPI number — MS. DIANE KATHLEEN MORGAN

Table of content: MS. DIANE KATHLEEN MORGAN (NPI 1619033586)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619033586 NPI number — MS. DIANE KATHLEEN MORGAN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MORGAN
Provider First Name:
DIANE
Provider Middle Name:
KATHLEEN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MORGAN-GRIFFITH
Provider Other First Name:
DIANE
Provider Other Middle Name:
KATHLEEN
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.S.W., L.C.S.W.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1619033586
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/08/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1304 S BROADWAY ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEAVENWORTH
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66048-3120
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
913-772-8960
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 W 19TH TER
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KANSAS CITY
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64108-2026
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-404-5709
Provider Business Practice Location Address Fax Number:
816-404-6024
Provider Enumeration Date:
12/28/2006

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:  2002030761 , 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: 497003301 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".