Provider Demographics
NPI:1417354390
Name:BOMBARDIER, XIAOWEI QIAO (LMLP)
Entity Type:Individual
Prefix:
First Name:XIAOWEI
Middle Name:QIAO
Last Name:BOMBARDIER
Suffix:
Gender:F
Credentials:LMLP
Other - Prefix:
Other - First Name:XIAOWEI
Other - Middle Name:
Other - Last Name:QIAO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6306 HEDGE LANE TER APT 102
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:KS
Mailing Address - Zip Code:66226-4818
Mailing Address - Country:US
Mailing Address - Phone:785-432-6426
Mailing Address - Fax:
Practice Address - Street 1:2708 W 43RD AVE
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66103-3125
Practice Address - Country:US
Practice Address - Phone:913-708-8247
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-20
Last Update Date:2016-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2583103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS051688Medicaid