Provider Demographics
NPI:1265590673
Name:SHANLINE, KRISTIAN ELIZABETH (MSW)
Entity type:Individual
Prefix:
First Name:KRISTIAN
Middle Name:ELIZABETH
Last Name:SHANLINE
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 1:7908 CAMPBELL ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64131-2155
Mailing Address - Country:US
Mailing Address - Phone:913-328-4698
Mailing Address - Fax:913-328-4603
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:913-328-4698
Practice Address - Fax:913-328-4603
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS4886104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS10098080AMedicaid
KS17-4602Medicare Oscar/Certification
KS3620000Medicare ID - Type UnspecifiedMEDICARE
KS3260000Medicare ID - Type UnspecifiedMEDICARE PART B