Active NPI
Angelique Dawn Collis, L.C.S.W.
- Clinical Social Worker
- Lees Summit, MO
National Provider Identifier
1306044532
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 2001028089
- Practice address
- 901 NE Independence Ave
Lees Summit, MO 64086-5544 - Phone
- (816) 347-3232
- Fax
- (816) 246-8207
- NPI assigned
- Jul 10, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 2001028089 | MO | Primary |
Addresses
Primary practice location
901 NE Independence Ave
Lees Summit, MO 64086-5544
Mailing address
901 NE Independence Ave
Lees Summit, MO 64086-5544
Phone (816) 347-3232
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 307F576C | Other | MO | MEDICARE PERF. PROV. # |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2001028089 | MO | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1184025600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1195516800000",
"number": "1306044532",
"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": "816-347-3232",
"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": "816-347-3232",
"fax_number": "816-246-8207"
}
],
"practiceLocations": [],
"basic": {
"last_name": "COLLIS",
"first_name": "ANGELIQUE",
"middle_name": "DAWN",
"credential": "L.C.S.W.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-07-10",
"last_updated": "2007-11-20",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MO",
"license": "2001028089",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE PERF. PROV. #",
"identifier": "307F576C",
"state": "MO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Lees Summit, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.