# INDIVIDUAL EXPRESSIONS, INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1225237993
- **Authorized official:** MR. MARK ROBERT FORTIN (PRESIDENT)
- **Authorized official phone:** (816) 509-5509

## Contact information

- **Practice address:** 3817 WOODSON DRIVE, RAYTOWN, MO 64138
- **Practice address phone:** (816) 509-5509
- **Practice address fax:** (816) 356-1207
- **Mailing address:** 507 SE 3RD ST, LEES SUMMIT, MO 64063-2810
- **Mailing address phone:** (816) 524-4745
- **Mailing address fax:** (816) 524-4751

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 320600000X | Intellectual and/or Developmental Disabilities Residential Treatment Facility | — | MO | Yes |

## Other

- **Enumeration date:** 07/13/2007
- **Last updated:** 07/13/2007