Provider Demographics
NPI:1184214215
Name:SAMPSON, KAITLYN N (PLPC)
Entity Type:Individual
Prefix:
First Name:KAITLYN
Middle Name:N
Last Name:SAMPSON
Suffix:
Gender:F
Credentials:PLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12351 W 96TH TER STE 105
Mailing Address - Street 2:
Mailing Address - City:LENEXA
Mailing Address - State:KS
Mailing Address - Zip Code:66215-4410
Mailing Address - Country:US
Mailing Address - Phone:913-257-3161
Mailing Address - Fax:
Practice Address - Street 1:225 SW NOEL ST
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64063-2241
Practice Address - Country:US
Practice Address - Phone:913-257-3161
Practice Address - Fax:888-965-8977
Is Sole Proprietor?:No
Enumeration Date:2021-01-22
Last Update Date:2021-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2020042238101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional