Provider Demographics
NPI:1033123963
Name:CONNAGHAN, KEVIN (LSCSW)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:
Last Name:CONNAGHAN
Suffix:
Gender:M
Credentials:LSCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4707 COLLEGE BLVD
Mailing Address - Street 2:SUITE 213
Mailing Address - City:LEAWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:66211-1603
Mailing Address - Country:US
Mailing Address - Phone:913-663-3000
Mailing Address - Fax:913-663-1115
Practice Address - Street 1:4707 COLLEGE BLVD
Practice Address - Street 2:SUITE 213
Practice Address - City:LEAWOOD
Practice Address - State:KS
Practice Address - Zip Code:66211-1603
Practice Address - Country:US
Practice Address - Phone:913-663-3000
Practice Address - Fax:913-663-1115
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSLSCSW 16871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100291030CMedicaid