Provider Demographics
NPI:1386615334
Name:SCANTLIN, PATRICK REGAN (LCSW)
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:REGAN
Last Name:SCANTLIN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10107 CENTRAL ST APT 307
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64114-4683
Mailing Address - Country:US
Mailing Address - Phone:816-943-6386
Mailing Address - Fax:
Practice Address - Street 1:3100 BROADWAY BLVD
Practice Address - Street 2:410
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64111-2658
Practice Address - Country:US
Practice Address - Phone:816-753-3333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-29
Last Update Date:2014-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0048321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOC168483OtherMEDICARE B WHEATLANDS
MO497990747Medicaid