Provider Demographics
NPI:1194890509
Name:FANGMAN, ESTHER (EDD)
Entity type:Individual
Prefix:
First Name:ESTHER
Middle Name:
Last Name:FANGMAN
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3741 FOREST AVE
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64109-2644
Mailing Address - Country:US
Mailing Address - Phone:816-753-2514
Mailing Address - Fax:816-753-2514
Practice Address - Street 1:3741 FOREST AVE
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64109-2644
Practice Address - Country:US
Practice Address - Phone:816-753-2514
Practice Address - Fax:816-753-2514
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSLCPC 028101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional