Provider Demographics
NPI:1700073202
Name:GIBSON, JULIE ANN (MSW, LCSW)
Entity type:Individual
Prefix:MS
First Name:JULIE
Middle Name:ANN
Last Name:GIBSON
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4401 NE VIVION RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64119-2807
Mailing Address - Country:US
Mailing Address - Phone:816-455-7450
Mailing Address - Fax:816-746-9850
Practice Address - Street 1:4401 NE VIVION RD
Practice Address - Street 2:SUITE 203
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64119-2807
Practice Address - Country:US
Practice Address - Phone:816-455-7450
Practice Address - Fax:816-746-9850
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-28
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0007121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO496679416Medicaid
0002788Medicare UPIN