Provider Demographics
NPI:1376767046
Name:HADER, CAROL ANN (MSW)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:ANN
Last Name:HADER
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 E 137TH ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64145-1455
Mailing Address - Country:US
Mailing Address - Phone:816-508-3628
Mailing Address - Fax:816-508-3797
Practice Address - Street 1:421 E 137TH ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64145-1455
Practice Address - Country:US
Practice Address - Phone:816-508-3628
Practice Address - Fax:816-508-3797
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO00012301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical