Provider Demographics
NPI:1205811429
Name:FOSSEY, ELIZABETH ANN (PHD)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:ANN
Last Name:FOSSEY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3100 NE 83RD ST
Mailing Address - Street 2:SUITE 2350
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64119-4400
Mailing Address - Country:US
Mailing Address - Phone:816-436-1721
Mailing Address - Fax:816-436-1180
Practice Address - Street 1:3100 NE 83RD ST
Practice Address - Street 2:SUITE 2350
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64119-4400
Practice Address - Country:US
Practice Address - Phone:816-436-1721
Practice Address - Fax:816-436-1180
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO01348103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO21479045OtherBLUE CROSS/BLUE SHIELD
MO0009551Medicare ID - Type Unspecified
MOR83040Medicare UPIN