Provider Demographics
NPI:1417984436
Name:CROSS, JON DAVID (MSW, LCSW, LSCSW)
Entity Type:Individual
Prefix:
First Name:JON
Middle Name:DAVID
Last Name:CROSS
Suffix:
Gender:M
Credentials:MSW, LCSW, LSCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18481 NORTHWIND DR
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66044-8348
Mailing Address - Country:US
Mailing Address - Phone:816-651-6600
Mailing Address - Fax:816-836-2220
Practice Address - Street 1:3923 S LYNN CT
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64055-3337
Practice Address - Country:US
Practice Address - Phone:816-836-2220
Practice Address - Fax:816-836-3567
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20040163491041C0700X
KS24731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO35903013OtherBLUE CROSS BLUE SHIELD