Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker | 2020016794 | MO |
NPI | 1003429135 |
---|---|
Provider Name | Sara Catherine O'connell |
First Address | Lees Summit, MO 64081-2163 |
Second Address | Kansas City, MO 64108-2026 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/08/2020 |
Last Update Date | 19/11/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
490088824 | (05) | MO |