Provider Demographics
NPI:1467625236
Name:ROSE, KATHERINE LEE (LMSW, LCSW)
Entity Type:Individual
Prefix:MS
First Name:KATHERINE
Middle Name:LEE
Last Name:ROSE
Suffix:
Gender:F
Credentials:LMSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2905 S 29TH ST
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64503-1115
Mailing Address - Country:US
Mailing Address - Phone:816-351-6169
Mailing Address - Fax:
Practice Address - Street 1:5800 NW BARRY RD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64154-1493
Practice Address - Country:US
Practice Address - Phone:816-505-3311
Practice Address - Fax:816-505-3511
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-11
Last Update Date:2009-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20080065571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical