Organization
INDIVIDUAL EXPRESSIONS, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MARK ROBERT FORTIN (PRESIDENT)
(816) 509-5509
Entity
Organization
Contact information
Practice address
3817 WOODSON DRIVE, RAYTOWN, MO 64138
(816) 509-5509
(816) 356-1207
Mailing address
507 SE 3RD ST, LEES SUMMIT, MO 64063-2810
(816) 524-4745
(816) 524-4751
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
—
MO
Other
Enumeration date
07/13/2007
Last updated
07/13/2007
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