Provider Demographics
NPI:1790709319
Name:RICHARDSON, JULIE MARIE (LSCSW)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:MARIE
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:LSCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4707 COLLEGE BLVD
Mailing Address - Street 2:STE. 207
Mailing Address - City:LEAWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:66211-1603
Mailing Address - Country:US
Mailing Address - Phone:913-645-5744
Mailing Address - Fax:816-478-9804
Practice Address - Street 1:4707 COLLEGE BLVD
Practice Address - Street 2:STE. 207
Practice Address - City:LEAWOOD
Practice Address - State:KS
Practice Address - Zip Code:66211-1603
Practice Address - Country:US
Practice Address - Phone:913-645-5744
Practice Address - Fax:816-478-9804
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSKS20001041C0700X
MOSW0059781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO000A465AMedicare ID - Type UnspecifiedMEDICARE MO
KS000A465Medicare ID - Type UnspecifiedMEDICARE KS