Individual
PETSAMON CHANTHALOME
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMSW
Contact information
Practice address
24007 W 80TH TER, LENEXA, KS 66227-2203
(913) 850-3069
Mailing address
24007 W 80TH TER, LENEXA, KS 66227-2203
(913) 850-3069
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
2015022687
MO
104100000X
Social Worker
Primary
9520
KS
Other
Enumeration date
02/17/2016
Last updated
02/17/2016
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