Provider Demographics
NPI:1821254061
Name:KEITEL, JACQUELINE ELAINE (LCSW, LSCSW)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:ELAINE
Last Name:KEITEL
Suffix:
Gender:F
Credentials:LCSW, LSCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7280 NW 87TH TER
Mailing Address - Street 2:SUITE 210
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64153-3720
Mailing Address - Country:US
Mailing Address - Phone:816-872-2463
Mailing Address - Fax:816-533-7220
Practice Address - Street 1:7280 NW 87TH TER
Practice Address - Street 2:SUITE 210
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64153-3720
Practice Address - Country:US
Practice Address - Phone:816-872-2463
Practice Address - Fax:816-533-7220
Is Sole Proprietor?:No
Enumeration Date:2008-08-06
Last Update Date:2010-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20030221971041C0700X
KS23871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical