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10109 E 63rd St Raytown MO 64133-5103 | |
| (816) 533-6308 | |
| (816) 662-7632 |
| Full Name | |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 10109 E 63rd St, Raytown, Missouri |
| Authorized Official Name and Position | Kenya Hicks (TRAUMA CLINICIAN) |
| Authorized Official Contact | 8166742657 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
10109 E 63rd St Raytown MO 64133-5103 Ph: (816) 533-6308 | 10109 E 63rd St Raytown MO 64133-5103 Ph: (816) 533-6308 |
| NPI Number | 1649861444 |
|---|---|
| Provider Enumeration Date | 02/03/2021 |
| Last Update Date | 01/17/2025 |
| Certification Date | 01/17/2025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1649861444 | NPI | - | NPPES |
| 1356964738 | Medicaid | MO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
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