Provider Demographics
NPI:1942325816
Name:UTLEY, AILEEN PAULA (PHD)
Entity Type:Individual
Prefix:
First Name:AILEEN
Middle Name:PAULA
Last Name:UTLEY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7255 RENNER RD
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:KS
Mailing Address - Zip Code:66217-3043
Mailing Address - Country:US
Mailing Address - Phone:913-596-3297
Mailing Address - Fax:913-962-1026
Practice Address - Street 1:7255 RENNER RD
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:KS
Practice Address - Zip Code:66217-3043
Practice Address - Country:US
Practice Address - Phone:913-596-3297
Practice Address - Fax:913-962-1026
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS849103TC1900X
MOPY01538103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO0006486Medicare ID - Type Unspecified