Provider Demographics
NPI:1265786610
Name:DVORAK, AMY LYNN
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:LYNN
Last Name:DVORAK
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:AMY
Other - Middle Name:LYNN
Other - Last Name:WHITE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1600 NW 66TH TER
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64118-2922
Mailing Address - Country:US
Mailing Address - Phone:816-820-6310
Mailing Address - Fax:
Practice Address - Street 1:306 S INDEPENDENCE ST
Practice Address - Street 2:
Practice Address - City:HARRISONVILLE
Practice Address - State:MO
Practice Address - Zip Code:64701-2352
Practice Address - Country:US
Practice Address - Phone:816-380-4010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-07
Last Update Date:2013-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional