Provider Demographics
NPI:1003022757
Name:CHRISTIFANO, KERRY SUE (MA)
Entity Type:Individual
Prefix:MRS
First Name:KERRY
Middle Name:SUE
Last Name:CHRISTIFANO
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14910 BIRCH ST
Mailing Address - Street 2:
Mailing Address - City:LEAWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:66224-3761
Mailing Address - Country:US
Mailing Address - Phone:913-685-8767
Mailing Address - Fax:
Practice Address - Street 1:9237 WARD PKWY STE 105
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64114-3357
Practice Address - Country:US
Practice Address - Phone:816-523-2200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2003032173101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional