Provider Demographics
NPI:1992907497
Name:BENNETT BOWIE, KATHY YVONNE (PSYD)
Entity type:Individual
Prefix:DR
First Name:KATHY
Middle Name:YVONNE
Last Name:BENNETT BOWIE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:KATHY
Other - Middle Name:YVONNE
Other - Last Name:BENNETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:4044 CENTRAL ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64111-2228
Mailing Address - Country:US
Mailing Address - Phone:816-960-4525
Mailing Address - Fax:
Practice Address - Street 1:4044 CENTRAL ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64111-2228
Practice Address - Country:US
Practice Address - Phone:816-960-4525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-05
Last Update Date:2010-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO01746103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO34998014OtherBCBS NON-PROVIDER NO.
MO000071206Medicare ID - Type UnspecifiedCLINICAL PSYCHOLOGIST