Provider Demographics
NPI:1619047701
Name:SCHOWENGERDT, CAROLYN
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:
Last Name:SCHOWENGERDT
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 1:10308 HORTON DR
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66207-3810
Mailing Address - Country:US
Mailing Address - Phone:816-333-0606
Mailing Address - Fax:816-523-5418
Practice Address - Street 1:6155 OAK ST
Practice Address - Street 2:SUITE E
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64113-2238
Practice Address - Country:US
Practice Address - Phone:816-333-0606
Practice Address - Fax:816-523-5418
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS081101Y00000X
MOPY01088103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101Y00000XBehavioral Health & Social Service ProvidersCounselor
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOJ399804AMedicare ID - Type Unspecified