Provider Demographics
NPI:1952415309
Name:PRICE, TERRIE LYNN (PHD)
Entity Type:Individual
Prefix:DR
First Name:TERRIE
Middle Name:LYNN
Last Name:PRICE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:TERRIE
Other - Middle Name:LYNN
Other - Last Name:FISK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:3011 BALTIMORE AVE
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64108-3403
Mailing Address - Country:US
Mailing Address - Phone:816-751-7732
Mailing Address - Fax:816-751-7981
Practice Address - Street 1:3011 BALTIMORE AVE
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64108-3403
Practice Address - Country:US
Practice Address - Phone:816-751-7732
Practice Address - Fax:816-751-7981
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO01299103G00000X
KS0694103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS119755Medicare ID - Type Unspecified
8012615AMedicare ID - Type UnspecifiedKANSAS CITY
R62142Medicare UPIN