Provider Demographics
NPI:1508405523
Name:VANSLYKE, ANDREW F (LMSW)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:F
Last Name:VANSLYKE
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:668 SE BAYBERRY LN STE 101
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64063-4366
Mailing Address - Country:US
Mailing Address - Phone:816-500-6436
Mailing Address - Fax:
Practice Address - Street 1:668 SE BAYBERRY LN STE 101
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64063-4366
Practice Address - Country:US
Practice Address - Phone:816-500-6436
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-23
Last Update Date:2019-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019046346104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker