Provider Demographics
NPI:1528243789
Name:WAITE, JULIE ANN (LCSW)
Entity type:Individual
Prefix:MS
First Name:JULIE
Middle Name:ANN
Last Name:WAITE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:ANN
Other - Last Name:GROMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:2715 SWOPE PKWY
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64130-2609
Mailing Address - Country:US
Mailing Address - Phone:816-923-1154
Mailing Address - Fax:816-923-1353
Practice Address - Street 1:2715 SWOPE PKWY
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64130-2609
Practice Address - Country:US
Practice Address - Phone:816-923-1154
Practice Address - Fax:816-923-1353
Is Sole Proprietor?:No
Enumeration Date:2008-01-07
Last Update Date:2021-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20100286991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2010028699OtherMISSOURI DIVISION OF PROFESSIONAL REGISTRATION