Wildwood Cottage

Primary specialty

Intellectual & Developmental Disabilities PsychologistTaxonomy code 103TM1800X

Legal business name

WILDWOOD COTTAGE

Practice address

11212 E 71St St
Raytown, MO 64133-6801

Phone

(816) 353-5274

Fax

(816) 353-1226

NPI assigned

Apr 18, 2008

Last updated

Apr 20, 2008By the provider in NPPES

Organization subpart

Yes

Parent organization

KMW,INC.As reported in NPPES

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

Authorized official

Name

Mrs. Virginia Mae Morgan

Title

Administrator-Owner

Phone

(816) 353-5274

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1208476800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208649600000",
    "number": "1770757841",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11212 E 71ST ST",
            "city": "RAYTOWN",
            "state": "MO",
            "postal_code": "641336801",
            "telephone_number": "816-353-5274",
            "fax_number": "816-353-1226"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11212 E 71ST ST",
            "city": "RAYTOWN",
            "state": "MO",
            "postal_code": "641336801",
            "telephone_number": "816-353-5274",
            "fax_number": "816-353-1226"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILDWOOD COTTAGE",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "KMW,INC.",
        "enumeration_date": "2008-04-18",
        "last_updated": "2008-04-20",
        "status": "A",
        "authorized_official_last_name": "MORGAN",
        "authorized_official_first_name": "VIRGINIA",
        "authorized_official_middle_name": "MAE",
        "authorized_official_title_or_position": "ADMINISTRATOR-OWNER",
        "authorized_official_telephone_number": "816-353-5274",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "103TM1800X",
            "taxonomy_group": "",
            "desc": "Psychologist, Intellectual & Developmental Disabilities",
            "state": "MO",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Intellectual & Developmental Disabilities Psychologist in Raytown, MO
• Providers in Raytown, MO by specialty
• Intellectual & Developmental Disabilities Psychologist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.