Provider Demographics
NPI:1760483598
Name:PFAFF, KRISTIE E (MSW, LCSW, LSCSW)
Entity Type:Individual
Prefix:
First Name:KRISTIE
Middle Name:E
Last Name:PFAFF
Suffix:
Gender:F
Credentials:MSW, LCSW, LSCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 NW 59TH ST
Mailing Address - Street 2:
Mailing Address - City:GLADSTONE
Mailing Address - State:MO
Mailing Address - Zip Code:64118-4021
Mailing Address - Country:US
Mailing Address - Phone:816-673-4889
Mailing Address - Fax:
Practice Address - Street 1:205 NW 59TH ST
Practice Address - Street 2:
Practice Address - City:GLADSTONE
Practice Address - State:MO
Practice Address - Zip Code:64118-4021
Practice Address - Country:US
Practice Address - Phone:816-673-4889
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-02
Last Update Date:2024-03-12
Deactivation Date:2013-02-05
Deactivation Code:
Reactivation Date:2016-05-10
Provider Licenses
StateLicense IDTaxonomies
MO20010127241041C0700X
KS21721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO758379804Medicaid
MOP91595Medicare UPIN
MO758379804Medicaid