Basic Information
| Provider Information | |||||||||
| NPI: | 1740633940 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | STORTENBECKER | ||||||||
| FirstName: | EMILY | ||||||||
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| Credential: | LMSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1332 NE PARVIN RD | ||||||||
| Address2: | 17303 | ||||||||
| City: | KANSAS CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 641165002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4025605373 | ||||||||
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| Practice Location | |||||||||
| Address1: | 200 MAINE ST | ||||||||
| Address2: | A | ||||||||
| City: | LAWRENCE | ||||||||
| State: | KS | ||||||||
| PostalCode: | 660441368 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7858439192 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/22/2016 | ||||||||
| LastUpdateDate: | 07/22/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 10083 | KS | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.