Provider Demographics
NPI:1467517722
Name:WENECK, ADA GILLESPIE (RN,LPC)
Entity Type:Individual
Prefix:
First Name:ADA
Middle Name:GILLESPIE
Last Name:WENECK
Suffix:
Gender:F
Credentials:RN,LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 22636
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64113-0636
Mailing Address - Country:US
Mailing Address - Phone:816-444-5710
Mailing Address - Fax:816-444-6425
Practice Address - Street 1:217 E 63RD ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64113-2224
Practice Address - Country:US
Practice Address - Phone:816-444-5710
Practice Address - Fax:816-444-6425
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO002388101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional