Individual
JERALD JEOFREY VANDEVOORT
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
LMSW
Contact information
Practice address
4101 S 4TH ST, LEAVENWORTH, KS 66048-5014
(913) 682-2000
Mailing address
1419 MARION ST, LEAVENWORTH, KS 66048-4139
(913) 651-7665
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
4315
KS
Other
Enumeration date
04/25/2006
Last updated
07/08/2007
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