Provider Demographics
NPI:1821405036
Name:BENITO, JESSICA AGUDELO (DSW, LCSW)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:AGUDELO
Last Name:BENITO
Suffix:
Gender:F
Credentials:DSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 901348
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64190-1348
Mailing Address - Country:US
Mailing Address - Phone:816-535-0975
Mailing Address - Fax:816-298-1452
Practice Address - Street 1:435 NICHOLS RD STE 200
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64112-2036
Practice Address - Country:US
Practice Address - Phone:816-368-2000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-20
Last Update Date:2020-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY092290104100000X
MO20180037901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial Worker