Individual
MR. MICHAEL JON VANDERWAAL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
4110 BALTIMORE AVE, KANSAS CITY, MO 64111-2303
(816) 200-2320
Mailing address
4049 CENTRAL ST, KANSAS CITY, MO 64111-2207
(816) 200-2320
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
2019021597
MO
1041C0700X
Clinical Social Worker
Primary
2021038693
MO
Other
Enumeration date
04/02/2020
Last updated
09/23/2021
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