Provider Demographics
NPI: | 1437224326 |
---|---|
Name: | BLESSING, WILLIAM (PHD) |
Entity Type: | Individual |
Prefix: | DR |
First Name: | WILLIAM |
Middle Name: | |
Last Name: | BLESSING |
Suffix: | |
Gender: | M |
Credentials: | PHD |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 1010 CARONDELET DR |
Mailing Address - Street 2: | SUITE 201 |
Mailing Address - City: | KANSAS CITY |
Mailing Address - State: | MO |
Mailing Address - Zip Code: | 64114-4859 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 816-590-3900 |
Mailing Address - Fax: | 816-942-8447 |
Practice Address - Street 1: | 1010 CARONDELET DR |
Practice Address - Street 2: | SUITE 201 |
Practice Address - City: | KANSAS CITY |
Practice Address - State: | MO |
Practice Address - Zip Code: | 64114-4859 |
Practice Address - Country: | US |
Practice Address - Phone: | 816-590-3900 |
Practice Address - Fax: | 816-942-8447 |
Is Sole Proprietor?: | Yes |
Enumeration Date: | 2006-11-23 |
Last Update Date: | 2008-08-20 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
MO | PYRO 280 | 103G00000X |
KS | 809 | 103G00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 103G00000X | Behavioral Health & Social Service Providers | Clinical Neuropsychologist |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
KS | 49 571385 02 | Medicaid | |
MO | 49 79357 18 | Medicaid | |
MO | 49 79357 18 | Medicaid | |
KS | 0003865A | Medicare PIN | |
MO | 0003865 | Medicare PIN |