Provider Demographics
NPI:1689779738
Name:RATLIFF, BASCOM WILLIAM (DSW)
Entity Type:Individual
Prefix:DR
First Name:BASCOM
Middle Name:WILLIAM
Last Name:RATLIFF
Suffix:
Gender:M
Credentials:DSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8606 W 108TH PL
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66210-1606
Mailing Address - Country:US
Mailing Address - Phone:913-338-4896
Mailing Address - Fax:913-681-5949
Practice Address - Street 1:10201 W 127TH ST
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66213-3215
Practice Address - Country:US
Practice Address - Phone:913-338-4896
Practice Address - Fax:913-681-5949
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSRAODAC 26101YA0400X
KSLSCSW 9301041C0700X
MOLCSW 47051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical