Individual
AMANDA BANTLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
21350 W 153RD ST, OLATHE, KS 66061-5413
(913) 322-2400
(913) 621-5730
Mailing address
2704 CABIN CREEK CT, EDWARDSVILLE, IL 62025-3023
(618) 789-2527
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
8013
KS
Other
Enumeration date
06/06/2011
Last updated
10/14/2021
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