Provider Demographics
NPI:1730169582
Name:MEHRER, GWENDOLYN JOY
Entity type:Individual
Prefix:MS
First Name:GWENDOLYN
Middle Name:JOY
Last Name:MEHRER
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:GWENDOLYN
Other - Middle Name:JOY
Other - Last Name:LIES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:PO BOX 1365
Mailing Address - Street 2:
Mailing Address - City:LIBERTY
Mailing Address - State:MO
Mailing Address - Zip Code:64069-1365
Mailing Address - Country:US
Mailing Address - Phone:816-781-2380
Mailing Address - Fax:
Practice Address - Street 1:2211 CHARLOTTE ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64108-2733
Practice Address - Country:US
Practice Address - Phone:816-404-6012
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0025801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical