1578642294 NPI number — MS. KAREN MAUREEN DULLEA MSW LSCSW

Table of content: MS. KAREN MAUREEN DULLEA MSW LSCSW (NPI 1578642294)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578642294 NPI number — MS. KAREN MAUREEN DULLEA MSW LSCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DULLEA
Provider First Name:
KAREN
Provider Middle Name:
MAUREEN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MSW LSCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BLICK
Provider Other First Name:
KAREN
Provider Other Middle Name:
MAUREEN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MSW LSCSW
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1578642294
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2024 NORTH WOODLAWN
Provider Second Line Business Mailing Address:
SUITE 411
Provider Business Mailing Address City Name:
WICHITA
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
67208-1879
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
316-684-2741
Provider Business Mailing Address Fax Number:
316-684-9261

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2024 NORTH WOODLAWN
Provider Second Line Business Practice Location Address:
SUITE 411
Provider Business Practice Location Address City Name:
WICHITA
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67208-1879
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
316-684-2741
Provider Business Practice Location Address Fax Number:
316-684-9261
Provider Enumeration Date:
11/03/2006

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:  LSCSW405 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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