Provider Demographics
NPI:1417027004
Name:SACK, DEANNA MARIE (LSCSW, LCP)
Entity Type:Individual
Prefix:MS
First Name:DEANNA
Middle Name:MARIE
Last Name:SACK
Suffix:
Gender:F
Credentials:LSCSW, LCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7501 COLLEGE BLVD.
Mailing Address - Street 2:SUITE 250
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66210-1944
Mailing Address - Country:US
Mailing Address - Phone:913-451-8550
Mailing Address - Fax:913-469-5266
Practice Address - Street 1:7501 COLLEGE BLVD.
Practice Address - Street 2:SUITE 250
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66210-1944
Practice Address - Country:US
Practice Address - Phone:913-451-8550
Practice Address - Fax:913-469-5266
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2008-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS282103T00000X
KS45801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO27192036OtherBCBS OF KC
KS27192036OtherBCBS OF KC
KS27192036OtherBCBS OF KC
Q49301Medicare UPIN
KSC58D998Medicare ID - Type Unspecified