Provider Demographics
NPI:1467759282
Name:KIDSPLAY, LLC
Entity Type:Organization
Organization Name:KIDSPLAY, LLC
Other - Org Name:DENISE WELLER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:B
Authorized Official - Last Name:WELLER
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LSCSW
Authorized Official - Phone:913-764-5463
Mailing Address - Street 1:405 S CLAIRBORNE RD
Mailing Address - Street 2:STE 1
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66062-1795
Mailing Address - Country:US
Mailing Address - Phone:913-764-5463
Mailing Address - Fax:913-764-4160
Practice Address - Street 1:405 S CLAIRBORNE RD
Practice Address - Street 2:STE 1
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66062-1795
Practice Address - Country:US
Practice Address - Phone:913-764-5463
Practice Address - Fax:913-764-4160
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-14
Last Update Date:2011-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS24101041C0700X
MO20040061821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200546110AMedicaid