Provider Demographics
NPI:1417200478
Name:GRAMLICH, ANNALISA (MS, MA)
Entity Type:Individual
Prefix:
First Name:ANNALISA
Middle Name:
Last Name:GRAMLICH
Suffix:
Gender:F
Credentials:MS, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5710 NW MICHAELS CV
Mailing Address - Street 2:
Mailing Address - City:PARKVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:64152-3340
Mailing Address - Country:US
Mailing Address - Phone:816-916-9642
Mailing Address - Fax:
Practice Address - Street 1:1029 PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64105-1334
Practice Address - Country:US
Practice Address - Phone:816-221-0305
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-16
Last Update Date:2012-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012014468101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health