Provider Demographics
NPI:1922257559
Name:BROSS, JUDITH BARBARA (LSCSW)
Entity Type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:BARBARA
Last Name:BROSS
Suffix:
Gender:F
Credentials:LSCSW
Other - Prefix:MS
Other - First Name:JUDITH
Other - Middle Name:BARBARA
Other - Last Name:BROSS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LSCSW
Mailing Address - Street 1:9987 BALLENTINE ST
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66214-2343
Mailing Address - Country:US
Mailing Address - Phone:913-888-1186
Mailing Address - Fax:
Practice Address - Street 1:9987 BALLENTINE ST
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66214-2343
Practice Address - Country:US
Practice Address - Phone:913-888-1186
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-18
Last Update Date:2012-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS14921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical