Provider Demographics
NPI:1184266157
Name:SKAGGS-KIMBROUGH, LINDA CARROL
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:CARROL
Last Name:SKAGGS-KIMBROUGH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 E 24TH ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64108-2776
Mailing Address - Country:US
Mailing Address - Phone:816-588-3474
Mailing Address - Fax:816-416-7098
Practice Address - Street 1:1000 E 24TH ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64108-2776
Practice Address - Country:US
Practice Address - Phone:816-965-1157
Practice Address - Fax:816-416-7098
Is Sole Proprietor?:No
Enumeration Date:2019-10-11
Last Update Date:2020-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2850101Y00000X
MO2019042839101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor