Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC2200X | Clinical Child & Adolescent Psychologist | 2019008527 | MO |
NPI | 1083260574 |
---|---|
Provider Name | Dr. Ayanda Chakawa |
First Address | Kansas City, MO 64111-2673 |
Second Address | Kansas City, MO 64111-2673 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/08/2019 |
Last Update Date | 12/08/2019 |