Provider Demographics
NPI:1912447004
Name:DAVIS-LEIGHTY, KENDRA DEANNE (LCSW)
Entity Type:Individual
Prefix:
First Name:KENDRA
Middle Name:DEANNE
Last Name:DAVIS-LEIGHTY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:KENDRA
Other - Middle Name:DEANNE
Other - Last Name:DAVIS- LEIGHTY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:1535 NE RICE RD
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64086-5849
Mailing Address - Country:US
Mailing Address - Phone:816-965-1612
Mailing Address - Fax:816-347-3209
Practice Address - Street 1:1535 NE RICE RD
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64086-5849
Practice Address - Country:US
Practice Address - Phone:816-965-1612
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-08
Last Update Date:2019-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20190215891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2019021589OtherLCSW