Individual provider Active NPI

Lisa J Daberkow Stalp, PHD

  • Psychologist
  • Kansas City, MO
National Provider Identifier
1063603561
Registry record updated May 6, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
01859 Issued in MO
Practice address
3011 Baltimore Ave
Kansas City, MO 64108-3403
Phone
(816) 751-7732
Fax
(816) 751-7981
NPI assigned
Aug 8, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 6, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X 01859 MO Primary

Addresses

Primary practice location

3011 Baltimore Ave
Kansas City, MO 64108-3403

Mailing address

3011 Baltimore Ave
Kansas City, MO 64108-3403
Phone (816) 751-7900

Other names 1

  • Lisa J Daberkow Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
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

Enrollment IDStateProvider typePAC IDDetails
I20090122000694 MO Practitioner - Clinical Psychologist 0840354676 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ability KCGroup PAC ID 0143116368, 166 clinicians

Practice addresses (Care Compare)

3011 Baltimore Ave
Kansas City, MO 64108-3403
Phone (816) 751-7832

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
01859MOMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Ability KC CurrentSince Jan 2, 2009 Accepting new patients

Locations

3011 Baltimore Ave
Kansas City, MO 64108
Phone (816) 751-7700

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1186531200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1557100800000",
    "number": "1063603561",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3011 BALTIMORE AVE",
            "city": "KANSAS CITY",
            "state": "MO",
            "postal_code": "641083403",
            "telephone_number": "816-751-7900",
            "fax_number": "816-751-7981"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3011 BALTIMORE AVE",
            "city": "KANSAS CITY",
            "state": "MO",
            "postal_code": "641083403",
            "telephone_number": "816-751-7732",
            "fax_number": "816-751-7981"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DABERKOW STALP",
        "first_name": "LISA",
        "middle_name": "J",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-08-08",
        "last_updated": "2019-05-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "MO",
            "license": "01859",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LISA",
            "last_name": "DABERKOW",
            "middle_name": "J",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Kansas City, MO

Sources for this page

Verify at the official NPI Registry.