Provider Demographics
NPI:1972594851
Name:EASON, ANNABELLE (MSW)
Entity Type:Individual
Prefix:
First Name:ANNABELLE
Middle Name:
Last Name:EASON
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8400 W 110TH ST
Mailing Address - Street 2:STE 410
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66210-2331
Mailing Address - Country:US
Mailing Address - Phone:913-485-6979
Mailing Address - Fax:913-491-1141
Practice Address - Street 1:8400 W 110TH ST
Practice Address - Street 2:STE 410
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66210-2331
Practice Address - Country:US
Practice Address - Phone:913-485-6979
Practice Address - Fax:913-491-1141
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-31
Last Update Date:2013-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS08391041C0700X
MO0030341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS00C879Medicare ID - Type UnspecifiedPROVIDER NUMBER