Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 1338 | KS |
Y | 103TC0700X | Clinical Psychologist | 1338 | KS |
NPI | 1003915893 |
---|---|
Provider Name | Monica F Kurylo |
First Address | Kansas City, KS 66160-7816 |
Second Address | Kansas City, KS 66160-7341 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/09/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
36197016 | BCBS KANSAS CITY (01) | MO |
P15029 | (02) |