Provider Demographics
NPI:1013056662
Name:SHIPPS, MONICA LYNN (LSCSW)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:LYNN
Last Name:SHIPPS
Suffix:
Gender:F
Credentials:LSCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4712 MUND RD
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:KS
Mailing Address - Zip Code:66218-9442
Mailing Address - Country:US
Mailing Address - Phone:913-441-8907
Mailing Address - Fax:
Practice Address - Street 1:1301 N 47TH ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66102-1705
Practice Address - Country:US
Practice Address - Phone:913-288-4238
Practice Address - Fax:913-287-0354
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS17781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS3629244OtherMY NUMBER
KS100098080AMedicaid
KS3620000Medicare ID - Type UnspecifiedMEDICARE B
KS17-4602Medicare Oscar/Certification