Provider Demographics
NPI:1659649119
Name:LANDRY, KATHERINE ANGELLE (MSW, LCSW, LSCSW)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:ANGELLE
Last Name:LANDRY
Suffix:
Gender:F
Credentials:MSW, LCSW, LSCSW
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:
Other - Last Name:LANDRY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:7000 W 121ST ST STE 100
Mailing Address - Street 2:
Mailing Address - City:LEAWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:66209-2010
Mailing Address - Country:US
Mailing Address - Phone:913-732-0636
Mailing Address - Fax:
Practice Address - Street 1:7000 W 121ST ST STE 100
Practice Address - Street 2:
Practice Address - City:LEAWOOD
Practice Address - State:KS
Practice Address - Zip Code:66209-2010
Practice Address - Country:US
Practice Address - Phone:913-732-0636
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-12
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20190337291041C0700X
COCSW.099245301041C0700X
KS057741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1659649119Medicaid