Provider Demographics
NPI:1598094278
Name:ATWOOD, SHEDRIKA (MA)
Entity Type:Individual
Prefix:
First Name:SHEDRIKA
Middle Name:
Last Name:ATWOOD
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12209 E 55TH ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64133-3106
Mailing Address - Country:US
Mailing Address - Phone:816-359-1581
Mailing Address - Fax:816-255-3408
Practice Address - Street 1:12209 E 55TH ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64133-3106
Practice Address - Country:US
Practice Address - Phone:816-359-1581
Practice Address - Fax:816-255-3408
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-09
Last Update Date:2009-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO320900000X
MO6207-11776322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities