Provider Demographics
NPI:1215021068
Name:ROBERTS, KATHRYN S (MS)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:S
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:KATY
Other - Middle Name:
Other - Last Name:ROBERTS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS
Mailing Address - Street 1:28 U ST
Mailing Address - Street 2:
Mailing Address - City:LAKE LOTAWANA
Mailing Address - State:MO
Mailing Address - Zip Code:64086-9755
Mailing Address - Country:US
Mailing Address - Phone:816-578-4135
Mailing Address - Fax:816-578-5449
Practice Address - Street 1:409 SE DOUGLAS ST
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64063-4246
Practice Address - Country:US
Practice Address - Phone:816-795-0004
Practice Address - Fax:816-578-5449
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO01428103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist