Provider Demographics
NPI:1922131853
Name:JACKEL, KINDRA SUSAN (LPC)
Entity Type:Individual
Prefix:MRS
First Name:KINDRA
Middle Name:SUSAN
Last Name:JACKEL
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6011 BROOKSIDE BLVD
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64113-1427
Mailing Address - Country:US
Mailing Address - Phone:816-582-8280
Mailing Address - Fax:
Practice Address - Street 1:400 E 6TH ST
Practice Address - Street 2:
Practice Address - City:PARKVILLE
Practice Address - State:MO
Practice Address - Zip Code:64152-3703
Practice Address - Country:US
Practice Address - Phone:816-452-8910
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004024712101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional