Provider Demographics
NPI:1083260574
Name:CHAKAWA, AYANDA (PHD)
Entity Type:Individual
Prefix:DR
First Name:AYANDA
Middle Name:
Last Name:CHAKAWA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3101 BROADWAY BLVD FL 10
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64111-2673
Mailing Address - Country:US
Mailing Address - Phone:816-234-3674
Mailing Address - Fax:
Practice Address - Street 1:3101 BROADWAY BLVD FL 10
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64111-2673
Practice Address - Country:US
Practice Address - Phone:816-234-3674
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-12
Last Update Date:2019-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019008527103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent