Provider Demographics
NPI:1861237711
Name:BAGUNU, REBECCA KAYLEIGH
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:KAYLEIGH
Last Name:BAGUNU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4200 LITTLE BLUE PKWY STE 360
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64057-8317
Mailing Address - Country:US
Mailing Address - Phone:816-710-8912
Mailing Address - Fax:
Practice Address - Street 1:4200 LITTLE BLUE PKWY STE 360
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64057-8317
Practice Address - Country:US
Practice Address - Phone:816-710-8912
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-01
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2022020363101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional