1639443674 NPI number — KATHLEEN WADDELL LSCSW

Table of content: MARIA FELICITA OLAZAGASTI PH (NPI 1821336223)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639443674 NPI number — KATHLEEN WADDELL LSCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KATHLEEN WADDELL LSCSW
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1639443674
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/07/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3600 SW BURLINGAME RD
Provider Second Line Business Mailing Address:
STE. 1A
Provider Business Mailing Address City Name:
TOPEKA
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66611-2053
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3600 SW BURLINGAME RD
Provider Second Line Business Practice Location Address:
SUITE 1A
Provider Business Practice Location Address City Name:
TOPEKA
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66611-2053
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
778-526-6400
Provider Business Practice Location Address Fax Number:
785-266-4000
Provider Enumeration Date:
03/07/2012

Additional Information

Authorized Official

Authorized Official Last Name:
WADDELL
Authorized Official First Name:
KATHLEEN
Authorized Official Middle Name:
W
Authorized Official Title or Position:
INDEPENDENT PRACTITIONER
Authorized Official Telephone Number:
78526644000

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , with the licence number:  LSCSW 1081 , 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)

  • Identifier: 100003400A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".




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