Individual
ANGELIQUE DAWN COLLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
L.C.S.W.
Contact information
Practice address
901 NE INDEPENDENCE AVE, LEES SUMMIT, MO 64086-5544
(816) 347-3232
(816) 246-8207
Mailing address
901 NE INDEPENDENCE AVE, LEES SUMMIT, MO 64086-5544
(816) 347-3232
(816) 246-8207
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
2001028089
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
307F576C
MEDICARE PERF. PROV. #
MO
Enumeration date
07/10/2007
Last updated
11/20/2007
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