Provider Demographics
NPI:1396238531
Name:GRANT, PATSY (LCSW)
Entity type:Individual
Prefix:
First Name:PATSY
Middle Name:
Last Name:GRANT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:LYNN
Other - Middle Name:
Other - Last Name:GRANT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:443 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64106-1350
Mailing Address - Country:US
Mailing Address - Phone:773-706-5301
Mailing Address - Fax:
Practice Address - Street 1:443 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64106-1350
Practice Address - Country:US
Practice Address - Phone:773-706-5301
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-12
Last Update Date:2018-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490088421041C0700X
KS47741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty