Basic Information
| Provider Information | |||||||||
| NPI: | 1316424419 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ADLER | ||||||||
| FirstName: | EMILY | ||||||||
| MiddleName: | SHOSHANA | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | LMSW | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 300 W 19TH TER | ||||||||
| Address2: | |||||||||
| City: | KANSAS CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 641082026 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8164045709 | ||||||||
| FaxNumber: | 8164045739 | ||||||||
| Practice Location | |||||||||
| Address1: | 300 W 19TH TER | ||||||||
| Address2: | |||||||||
| City: | KANSAS CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 641082026 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8164045709 | ||||||||
| FaxNumber: | 8164045739 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/23/2018 | ||||||||
| LastUpdateDate: | 11/12/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
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| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 11/12/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 10370 | KS | N | Behavioral Health & Social Service Providers | Social Worker | 104100000X | 2018012449 | MO | Y | Behavioral Health & Social Service Providers | Social Worker |
ID Information
| ID | Type | State | Issuer | Description | 490058232 | 05 | MO | MEDICAID | 10098080C | 01 | KS | SED WAIVER | OTHER | 100098080A | 05 | KS | MEDICAID | 3620000 | 01 | KS | MEDICARE | OTHER |