Provider Demographics
NPI:1619033586
Name:MORGAN, DIANE KATHLEEN
Entity Type:Individual
Prefix:MS
First Name:DIANE
Middle Name:KATHLEEN
Last Name:MORGAN
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:DIANE
Other - Middle Name:KATHLEEN
Other - Last Name:MORGAN-GRIFFITH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSW, LCSW
Mailing Address - Street 1:1304 S BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:LEAVENWORTH
Mailing Address - State:KS
Mailing Address - Zip Code:66048-3120
Mailing Address - Country:US
Mailing Address - Phone:913-772-8960
Mailing Address - Fax:
Practice Address - Street 1:300 W 19TH TER
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64108-2026
Practice Address - Country:US
Practice Address - Phone:816-404-5709
Practice Address - Fax:816-404-6024
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20020307611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO497003301Medicaid