Provider Demographics
NPI:1598211526
Name:GRAVITT, DAESHEONNA LATRICE
Entity Type:Individual
Prefix:
First Name:DAESHEONNA
Middle Name:LATRICE
Last Name:GRAVITT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7610 LOMA VISTA DR
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64138-4041
Mailing Address - Country:US
Mailing Address - Phone:816-372-4432
Mailing Address - Fax:
Practice Address - Street 1:7610 LOMA VISTA DR
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64138-4041
Practice Address - Country:US
Practice Address - Phone:816-372-4432
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-30
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker