1881145498 NPI number — MRS. SANDIE W KREISER LSCSW

Table of content: MRS. SANDIE W KREISER LSCSW (NPI 1881145498)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881145498 NPI number — MRS. SANDIE W KREISER LSCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KREISER
Provider First Name:
SANDIE
Provider Middle Name:
W
Provider Name Prefix Text:
MRS.
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:
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:
1881145498
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/27/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
920 N TYLER RD
Provider Second Line Business Mailing Address:
STE 104
Provider Business Mailing Address City Name:
WICHITA
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
67212-3267
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
316-469-4543
Provider Business Mailing Address Fax Number:
316-636-7122

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
920 N TYLER RD
Provider Second Line Business Practice Location Address:
STE 104
Provider Business Practice Location Address City Name:
WICHITA
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67212-3267
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
316-469-4543
Provider Business Practice Location Address Fax Number:
316-636-7122
Provider Enumeration Date:
10/18/2016

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: 104100000X , with the licence number:  9161 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: 4788 , 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: 201146020A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com