Provider Demographics
NPI:1457399974
Name:BURKE, GWENDOLYN D (LCSW, LSCSW)
Entity Type:Individual
Prefix:
First Name:GWENDOLYN
Middle Name:D
Last Name:BURKE
Suffix:
Gender:F
Credentials:LCSW, LSCSW
Other - Prefix:
Other - First Name:GWENDOLYN
Other - Middle Name:D
Other - Last Name:PARKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW, LSCSW
Mailing Address - Street 1:1010 CARONDELET DR
Mailing Address - Street 2:SUITE 412
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64114-4859
Mailing Address - Country:US
Mailing Address - Phone:816-210-4982
Mailing Address - Fax:816-763-6540
Practice Address - Street 1:1010 CARONDELET DR
Practice Address - Street 2:SUITE 412
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64114-4859
Practice Address - Country:US
Practice Address - Phone:816-210-4982
Practice Address - Fax:816-763-6540
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2008-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20030037101041C0700X
KS22911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO35405OtherCOMMCARE
MOC16D620OtherMEDICARE B WHEATLANDS
MO499357002Medicaid
MO499357028Medicaid
MO7736772OtherAETNA
MO9369366OtherPHCS
MO35268043OtherBCBSKC PPO
MO499357010Medicaid
MO499357028Medicaid