Basic Information
| Provider Information | |||||||||
| NPI: | 1871507459 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BOLDRIDGE | ||||||||
| FirstName: | FLORA | ||||||||
| MiddleName: | L | ||||||||
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| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | PERKINS | ||||||||
| OtherFirstName: | FLORA | ||||||||
| OtherMiddleName: | L | ||||||||
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| OtherCredential: | LCSW | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 7719 CHERRY ST | ||||||||
| Address2: | |||||||||
| City: | KANSAS CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 641312067 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8163631231 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 6155 OAK ST | ||||||||
| Address2: | SUITE E | ||||||||
| City: | KANSAS CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 641132238 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8163330606 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/28/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 000317 | MO | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.