Provider Demographics
NPI:1295015386
Name:KAY, KRISTIN M (LSCSW)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:M
Last Name:KAY
Suffix:
Gender:F
Credentials:LSCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 PEACEFUL RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:GALENA
Mailing Address - State:MO
Mailing Address - Zip Code:65656-7467
Mailing Address - Country:US
Mailing Address - Phone:816-258-4669
Mailing Address - Fax:
Practice Address - Street 1:60 PEACEFUL RIDGE RD
Practice Address - Street 2:
Practice Address - City:GALENA
Practice Address - State:MO
Practice Address - Zip Code:65656-7467
Practice Address - Country:US
Practice Address - Phone:816-258-4669
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-22
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20230067941041C0700X
WI11343-1231041C0700X
KSLSCSW 44141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200736830AMedicaid