Provider Demographics
NPI:1932255023
Name:CROCKETT, KATHRYN LYNDSAY (SOCIAL WORKER)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:LYNDSAY
Last Name:CROCKETT
Suffix:
Gender:F
Credentials:SOCIAL WORKER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:702 N 75TH ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66112-2829
Mailing Address - Country:US
Mailing Address - Phone:913-299-9457
Mailing Address - Fax:913-299-1649
Practice Address - Street 1:702 N 75TH ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66112-2829
Practice Address - Country:US
Practice Address - Phone:913-299-9457
Practice Address - Fax:913-299-1649
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator