Provider Demographics
NPI:1841221025
Name:QUIGLEY, MARY K (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:K
Last Name:QUIGLEY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6707 N HOLMES ST
Mailing Address - Street 2:
Mailing Address - City:GLADSTONE
Mailing Address - State:MO
Mailing Address - Zip Code:64118-3420
Mailing Address - Country:US
Mailing Address - Phone:816-531-7737
Mailing Address - Fax:816-531-7738
Practice Address - Street 1:3210 GILLHAM RD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64109-1714
Practice Address - Country:US
Practice Address - Phone:816-531-7737
Practice Address - Fax:816-531-7738
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20020112201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO49594100Medicaid