Provider Demographics
NPI:1811370406
Name:CLARK-WHEELER, CASSANDRA M
Entity Type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:M
Last Name:CLARK-WHEELER
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 1:4230 S PHELPS RD
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64055-5067
Mailing Address - Country:US
Mailing Address - Phone:816-478-9031
Mailing Address - Fax:816-350-3406
Practice Address - Street 1:15010 E 51ST ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64136-1142
Practice Address - Country:US
Practice Address - Phone:816-478-9031
Practice Address - Fax:816-350-3406
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-01
Last Update Date:2015-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities