Connie Mae Putthoff, LSCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

2004025819 Issued in MO

Practice address

901 NE Independence Ave
Lees Summit, MO 64086-5544

Phone

(816) 347-3017

Fax

(816) 246-8207

NPI assigned

Jan 19, 2007

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in KS

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Wyandot Center for Community Behavioral Healthcare, Inc.

  dba Wyandot Inc.

  • Community/Behavioral Health Agency
  • Kansas City, KS
  • NPI 1629159389
  Medicare reassignment

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1169164800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1461628800000",
    "number": "1053464297",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "901 NE INDEPENDENCE AVE",
            "city": "LEES SUMMIT",
            "state": "MO",
            "postal_code": "640865544",
            "telephone_number": "816-347-3017",
            "fax_number": "816-246-8207"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "901 NE INDEPENDENCE AVE",
            "city": "LEES SUMMIT",
            "state": "MO",
            "postal_code": "640865544",
            "telephone_number": "816-347-3017",
            "fax_number": "816-246-8207"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PUTTHOFF",
        "first_name": "CONNIE",
        "middle_name": "MAE",
        "name_prefix": "Mrs.",
        "credential": "LSCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-19",
        "last_updated": "2016-04-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "KS",
            "license": "2479",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MO",
            "license": "2004025819",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100098080A",
            "state": "KS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SED WAIVER",
            "identifier": "100098080C",
            "state": "KS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Grace C Przekurat, FNP
• Psychpros of Kansas City
• Justin Puch, MA, LPC
• Kristen Nichole Pucket, PTA
• Sherry Ann Purvis, PT, BSPT
• Azhin O Qadir, PHARMD
• Darren B Quaile, P.A.-C.
• Qualicare KC
• Ashley Qualls, RN, FNP-C
• Taylor D Qualls, MA

• Clinical Social Worker in Lee's Summit, MO
• Providers in Lee's Summit, MO by specialty
• Clinical Social Worker in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 26, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.