1851515340 NPI number — KATHERINE SUE BLEVINS LSCSW

Table of content: KATHERINE SUE BLEVINS LSCSW (NPI 1851515340)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851515340 NPI number — KATHERINE SUE BLEVINS LSCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BLEVINS
Provider First Name:
KATHERINE
Provider Middle Name:
SUE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LSCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WRIGHT
Provider Other First Name:
KATHERINE
Provider Other Middle Name:
SUE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LSCSW
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1851515340
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/17/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4105 W 6TH ST
Provider Second Line Business Mailing Address:
STE B10
Provider Business Mailing Address City Name:
LAWRENCE
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66049-4696
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
785-840-0374
Provider Business Mailing Address Fax Number:
785-424-7684

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4105 W 6TH ST
Provider Second Line Business Practice Location Address:
STE B10
Provider Business Practice Location Address City Name:
LAWRENCE
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66049-4696
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-840-0374
Provider Business Practice Location Address Fax Number:
785-424-7684
Provider Enumeration Date:
04/13/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  3796 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 101YA0400X , with the licence number: 142 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)